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Cardiopulmonary Cerebral Resuscitation Post-Arrest Care 1405

Cardiopulmonary Cerebral Resuscitation Post-Arrest Care
VetBooks.ir ROSC

RESPIRATORY Spontaneous breathing? NO
Spontaneous breathing?
OPTIMIZATION
YES
IPPV
IPPV
PaCO or EtCO +5 mm Hg or EtCO + 5 mm Hg
PaCO 2 2 2 2
Dog = 32-43 mm Hg?Dog = 32-43 mm Hg?
Cat = 26-36 mm Hg?Cat = 26-36 mm Hg? NO
YES
YES
NO
FiO2 0.6
Titrate supplemental oxygen
Titrate supplemental oxygen FiO 2 ≥ 0.6
2
SpO 2 > 98% SpO = 94%-98% SpO < 94%
2
PaO > 100 mm Hg PaO = 80-100 mm Hg PaO < 80 mm Hg
2
2
2
Hyperoxemic Normoxemic Hypoxemic
SAP > 200 mm Hg SAP = 100-200 mm Hg SAP < 100 mm Hg
MAP > 120 mm Hg MAP = 80-120 mm Hg MAP < 80 mm Hg
Hypertensive Normotensive Hypotensive

70%
1 1 SCVO ≥ ≥ 70% NO 1 1
2
SCVO 2
Hypovolemia?
↓ Pressor Lactate < 2.5 Hypovolemia?
↓ Pressor
Lactate < 2.5
< 10 mm H
CVP
O?
mmol/L? CVP < 10 mm H O?
mmol/L?
2 2
2 2
Treat pain YES YES
Treat pain
IV fluids
3 3 IV fluids
Anti-
Anti-
hypertensive 2 2
hypertensive
Vasodilation?
Vasodilation?
↓ CRT, Injected MM?
↓ CRT, Injected MM?
YES
Vasopressor
Vasopressor
4 4 3 3
PCV < 25%?
PCV < 25%? ↓ Contractility?
↓ Contractility?
YES YES
+ Inotrope
Transfuse
T ransfuse + Inotrope
HEMODYNAMIC
OPTIMIZATION
Clinical Algorithms
NEUROPROTECTION
NEUROPROTECTION
ICU
ICU
Consider:
Consider:
• Hypothermia if comatose
• Mannitol/HTS if neuro signs
• Seizure prophylaxis
Post-cardiac arrest (PCA) care algorithm. This chart summarizes a comprehensive treatment protocol for PCA care that includes
components of controlled ventilation and oxygenation, goal-directed hemodynamic optimization, and neuroprotective strategies.
The sequence shown reflects the order in which each component should be assessed and treatment initiated. Assessment and
initiation of treatment for the subsequent component will likely commence before the endpoints of the previous component have
been completely met. Thus respiratory, hemodynamic, and neuroprotective treatment strategies will be initiated in parallel in most
cases.
CRT, Capillary refill time; CVP, central venous pressure; EtCO , end-tidal carbon dioxide; HTS, hypertonic saline; ICU, intensive
2
care unit; IPPV, intermittent positive pressure ventilation; MAP, mean arterial pressure; MM, mucous membrane color; PaO 2 , partial
pressure of oxygen, arterial; PCV, packed cell volume; ROSC, return of spontaneous circulation; SAP, systolic arterial pressure;
SCVO , central venous oxygen saturation; SpO 2 , peripheral capillary oxygen saturation.
2
(From Fletcher DJ, et al: RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines. J Vet Emerg Crit Care. 22(S1):S102–S131, 2012.)
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