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:
- Verify ROSC.
- Manage the airway and provide a breath every 5-6 seconds. 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 victim’s oxygen saturation >94%.
- Insert and maintain an IV for medication administration. Maintain the blood pressure above 90 mm Hg. For a low blood pressure, consider one or more of these treatments:
- Give 1 to 2 liters of saline or Ringer’s lactate IV fluid.
- Start an epinephrine IV infusion to keep the systolic pressure > 90 mmHg.
- Start a dopamine IV infusion
- Consider norepinephrine for extremely low systolic blood pressure.
- Evaluate the H’s and T’s for treatable causes (see H’s and T’s)
- Track the victim’s mental status. For decreased level of consciousness after resuscitation, consider inducing hypothermia.
- Obtain a 12-lead ECG to determine if the victim has suffered an ST segment elevation myocardial infarction (STEMI) or non-STEMI myocardial infarction.
- If myocardial infarction is suspected, consider percutaneous coronary intervention (PCI) to open the coronary arteries.
- When myocardial infarction is not suspected, or after PCI, transfer the victim to a Coronary Care Unit for advanced critical care.