Board Review: Critical Care
60 year old male, presents to the hospital as a cardiac arrest. After recognition of ventricular fibrillation, you successfully achieve ROSC with early CPR and defibrillation. The patient remains comatose. What is recommended post-resuscitation for this patient?
Maintain temperature at 30 degrees celsius for 24 hours
Obtain an electroencephalogram
Targeted glucose range 90-130
Maintain oxygen saturation at 100%
Answer: B. obtain an electroencephalogram
After cardiac arrest, the American Heart Association recommends early coronary artery catheterization (if suspected cardiac etiology), maintenance of hypothermia (between 32 and 36 degrees for 24 hours), controlled reoxygenation >94%, and avoidance of hypotension. For comatose patients, it’s recommended to obtain EEG to assess for subclinical seizure. About 12-22% of patient’s after cardiac arrest that remain comatose have epileptiform activity, and this can lead to worsening neurologic outcomes if not detected.
Callaway CW, Donnino MW, Fink EL, et al. Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S465–82.
Krumholz A, Stern BJ, Weiss HD. Outcome from coma after cardiopulmonary resuscitation: relation to seizures and myoclonus. Neurology 1988; 38:401.