Once the patient's basic heart and respiratory functions have been restarted through emergency care, teams of healthcare providers should evaluate the patient's condition and create a care plan that's as comprehensive as resources allow.
The care plan must be prioritized and executed in the proper order to optimize the patient's outcome and help prevent premature withdrawal of care.
Variation in patient condition — ranging from awake, aware and stable to comatose and unstable with ongoing conditions that caused the arrest — means that every patient's care plan will be different and determined by that patient's healthcare team.
- First 20 minutes after return of spontaneous circulation (ROSC).
- 20 minutes to 6-12 hours: early intervention is most effective.
- 6-12 hours to 72 hours: injury pathways still active; aggressive treatment recommended.
- Beyond 72 hours: recovery phase; outcomes more predictable.
- Long-term: rehabilitation.
Tests, Treatments and Procedures
The survivor should be admitted to the Intensive Care Unit (ICU) with treatment and monitoring for:
- Continued cardiac monitoring with telemetry
- Respiratory function
- Blood oxygen levels
- Blood sugar levels
- Blood chemistry
- Blood pressure
- Heart functions including heart rate and rhythm
- Brain function and intracranial pressure (EEG)
- Body temperature
- Fluid intake and urine output
Tests, treatments and procedures are intended to stabilize the survivor and fix the cause of the arrest:
- Coronary angiography and percutaneous coronary intervention (PCI — formerly called angioplasty): especially for survivors with acute myocardial infarction (heart attack) and coronary artery disease, or any patient suspected of having Acute Coronary Syndrome.
- Thrombolysis, if no facilities for PCI: in patients with certain types of heart attacks.
- Placement of artifical pacemaker or implantable cardioverter defibrillator (ICD): in survivors whose arrest was caused by arrhythmias.
- Induced therapeutic hypothermia: Cooling the body to slow malfunctioning processes, ideally for at least 24 hours, is especially recommended in comatose adult patients but may be appropriate for others.
- Coronary Artery Bypass Graft (CABG): in patients with left main coronary artery stenosis or 3-vessel CAD.
- Mechanical ventilation (breathing machine)
- Catheter Ablation: in patients with some types of arrhythmias but without other heart disease.
- Heart transplant: in patients with severe structural heart disease.
- Medications to stabilize heart functions and blood chemistry; to sedate the patient; to prevent or control seizures, and to control conditions that led to the arrest.
- Dialysis: in patients with kidney failure.
Management: care for survivor's condition
- Treatment for the condition that caused arrest may be life-long. Understand and follow your healthcare providers' instructions.
- Patients with neurological or physical impairments may need long-term medical management and daily care. Check with your hospital or community social services for resources available to you.
Rehabilitation: restore normal functioning
- Survivors may reach a relatively complete recovery with the help of neurological, physical and cardiac rehabilitation.
- Your healthcare team should provide a complete post-discharge care plan. Understand and follow it.
- If you can't find or can't afford rehabilitation, ask your healthcare provider or your hospital's social workers for help and guidance.
Prevention: don't suffer another arrest
Follow all of your healthcare providers' instructions about medications, devices, procedures and lifestyle changes to:
"This content was last reviewed on 07/12/2011."