Post‐resuscitation Therapy in Adult Advanced Life Support. ARC and NZRC Guideline 2010

After the return of a spontaneous circulation (ROSC), resuscitation DOES NOT STOP. It is essential to continue maintenance of airway, breathing and circulation. ROSC is just the first step toward the goal of complete recovery from cardiac arrest. Interventions in the postresuscitation period are likely to significantly influence the final outcome. A comprehensive treatment protocol including multiple interventions provided in a structured way may improve survival after cardiac arrest. Hypoxic brain injury, myocardial injury or subsequent organ failure are the predominant causes of morbidity and mortality after cardiac arrests. The aims of therapy after initial resuscitation are to: • Continue respiratory support. • Maintain cerebral perfusion. • Treat and prevent cardiac arrhythmias. • Determine and treat the cause of the arrest. In addition treatable causes of cardiac arrest need to be addressed. These include: • Hypoxaemia • Hypovolaemia • Hypo/Hyperkalaemia and other metabolic disorders including acidosis and disturbances of magnesium and calcium • Hypo/Hyperthermia • Tension pneumothorax • Tamponade: pericardial • Toxins/poisons/drugs including carbon monoxide, and cyclic antidepressants • Thrombosis: pulmonary embolus /acute myocardial infarction A full history and examination will guide the possible investigations. Electrolyte disorders such as hypoand hyper-natraemia may cause continuing cerebral damage. Serum electrolytes, arterial blood gases and ECG should be performed to guide further treatment. Treatment recommendations