ACLS Post Cardiac Arrest Care Algorithm

Treatment for a victim of cardiac arrest must continue post resuscitation in order to optimize the outcomes. The post cardiac arrest care algorithm includes the following steps:

1. Verify ROSC.
2. Manage the airway including ETT placement and provide 10 breaths per minute.
3. Using quantitative waveform capnography, titrate the oxygen to maintain a PETCO₂ of 35-40 mm Hg. If you do not have access to a waveform capnography machine, titrate oxygen to keep the oxygen saturation 92% to 98%.
4. Insert and maintain an IV for medication administration. Maintain systolic blood pressure above 90 mm Hg and/or mean arterial pressure above 65 mm Hg. For a low blood pressure, consider one or more of these treatments:
   1. Give 1 to 2 liters of saline or Ringer’s lactate IV fluid.
   2. Start an epinephrine IV or a dopamine IV infusion
   3. Consider norepinephrine for extremely low systolic blood pressure.
5. Obtain a 12-lead ECG and rule out myocardial infarction. If myocardial infarction is suspected, consider percutaneous coronary intervention (PCI) to open the coronary arteries.
6. Determine if the patient is comatose.
   1. If comatose:
      1. Targeted temperature management ASAP keeping body temp 32-36°C for 24 hours initially.
      2. Monitor EEG and assess for nonconvulsive seizures (treat if present)
      3. Obtain head CT
      4. Maintain oxygen, glucose, carbon dioxide, etc.
      5. Avoid barotrauma
   2. If NOT comatose (awake):
      1. Maintain oxygen, glucose, carbon dioxide, etc.
      2. Avoid barotrauma