This episode focuses on post–cardiac arrest care from the nursing perspective. Patients who achieve ROSC are super-critically ill because of brain ischemia, myocardial stunning, vasodilation from a SIRS-like state, and potential injury from underlying pathology. Nurses must be proactive, not reactive.
Most of these recs come from this paper:
Joint Guidelines AHA/NCS for Post-Cardiac Arrest Care
Initial Care
Stabilize
Pressors
ECGs
Repeat
Cath for OMI
Sickest Patient in the Hospital (and in Medicine?)
- Brain Injury
- Myocardial Dysfunction
- SIRS
- Underlying Pathology
Transfer???
Nursing Ratios
Swarm and then optimally 1:1 minimum, if possible
Proactive vs. Reactive Nursing
Find the Cause
ECG, Echo, Labs, Blood Gases, CT Scan
Blood Pressure/Hemodynamics
Arterial Line
Central Line
Full-Sterile
MAP Goals
Push to 80 if you can (NOTE the recent AHA guidelines (2025) have put MAP>65 as their recommendation)
Bare minimum 65
Norepi, Scott likes earlier vasopressin
Minimal fluid (infusions have more than enough)
ECHO/Inotropes
Steroids
ECMO
Ventilator Stuff
Vent Settings
4-8 ml/kg IBW
O2/CO2 Goals
92-98%
35-45
ETCO2
Pneumonia Protection
HOB
Inline Suction
ABX
Sedation
Propofol
CT Scan
Head, Triple Scan Chest, Abd/Pelvis
Ideally go before Arctic Sun Placement
Temperature Control
Monitoring Devices
Use temp-sensing foley
If not, use esophageal, not rectal
Video to Pass the Esophageal Probe
Need to have temp boxes and cables
Use your monitor or a hypothermia machine
Temp Goal
Absolute Febrile
32-34 vs. 37, never do 36 anymore
If doing Hypothermia
Shivering
Sedation
Need a good machine-Arctic Sun or Invasive Catheters
Pads must touch patient skin
If Doing Normothermia/Fever Prevention
Scheduled Antipyretics
Machine and Pads in the Room
Spontaneous Hypothermia
Machine rewarming 0.25-05
Neuro Stuff
Seizures
Continuous EEG
NeuroPrognostication
Organ Donation
Review Papers & Guidelines
More on EMCrit
- EMCrit 114 – Post-Arrest Care in 2013 with Stephen Bernard – Part II
- Post-cardiac arrest management (including neuroprognostication)
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Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Question that occurred to me during this episode: we have a study showing head-up positioning worsens Neuro outcomes in ischemic stroke pending thrombectomy likely due to decreased cerebral flow. In this episode, you advocate for head-up positioning but also endorse AHA/NCCS guidelines for increased MAP to improve cerebral perfusion. It seems like those are at odds with each other from a pathophysiologic standpoint. I couldn’t find any data for this but curious on your thoughts. Thanks for another great episode!
it’s a great ? You can’t nurse flat for extended period from a lung standpoint. Perhaps the MAP push of 80 is actually accounting for this fact.