4.2. ASSISTANCE TO ADULT PATIENTS AFTER RESTORATION OF SPONTANEOUS CIRCULATION

Related names:

None.

Purpose of assistance

Cardiac arrest in non-clinical settings in the States has a mortality rate of more than 90% and causes about 300,000 deaths annually. Many of those who survive suffer serious neurological complications. Current studies have shown that helping patients in a specialized hospital whose spontaneous circulation has returned leads to reduced mortality and improved neurological complications.

Accordingly, the goal is to stabilize neurological and other functions after the return of spontaneous circulation after CPR due to cardiac arrest.

Patient description

Inclusion criteria

A patient who regained spontaneous circulation after resuscitation due to cardiac arrest.

Exclusion criteria

There are no recommendations.

Patient Management

Condition assessment, treatment, intervention

1. Provide general patient care.

2. Eliminate life-threatening conditions associated with the respiratory tract, breathing and circulation. Closely monitor the patient because of the likelihood of repeated stop of blood circulation.

3. Perform oxygen therapy with the target achievement of saturation at the level of 94-98%. Do not bring to a state of hyperoxygenation.

4. Avoid hyperventilation. Keep the respiratory rate at 6-8 per minute and the ejection rate SO2 30-40 mm Hg.

5. In hypotension (systolic blood pressure below 90 or mean blood pressure below 65) see instruction “Shock.”

6. Record the ECG in 12-leads.

7. Check glucose levels:

a) for hypoglycemia, provide assistance in accordance with the instruction “Hypoglycemia”;
b) in case of hyperglycemia, inform the hospital admission department upon arrival.

8. If there is a court, provide assistance in accordance with the instruction “Convulsions.”

9. Patients with blood circulation arrest and signs of myocardial infarction with ST elevation (acute myocardial infarction) should be taken to any hospital where it is possible to perform percutaneous coronary interventions in the coronary catheterization unit.

10. Take the patient to a department that provides specialized care to patients who have survived circulatory arrest.

11. Prevent the onset of hyperthermia

Patient safety

1. Avoid hyperthermia.
2. Routine therapeutic hypothermia in prehospital conditions is not recommended

Useful information for training

Key points

1. Hyperventilation is a serious cause of hypotension and recurrent circulatory arrest after the resuscitation phase, and should be avoided.
2. Most patients require supportive ventilation after resuscitation.
3. The condition of patients after overcoming the stop of blood circulation changes quickly and constantly, so they need active monitoring. In most patients, after the return of spontaneous circulation, a repeated stop occurs.
4. A moderate number of patients upon return of spontaneous circulation may have evidence of MI with ST elevation on ECG.
5. A typical cause of post-animation hypotension is hyperventilation, hypovolemia, and pneumothorax.

Relevant evaluation results

Assessment of heart rhythm after the return of spontaneous circulation, respiratory murmurs, signs of hypoperfusion.

Key elements of documentation

1. Heart rate immediately after circulatory arrest, vital signs, oxygen saturation, neurological evaluation.
2. 12-lead ECG readings after restoration of spontaneous circulation.

Criteria for the effectiveness of care

The percentage of patients with restored spontaneous circulation who were taken to the appropriate admission department, which is predetermined by the EMF for these patients.