Neuroprotection following Cardiac Arrest - Guidelines for Crises in Anaesthesia

Outcome from cardiac arrest is determined by the severity of any supervening neurological or cardiac dysfunction / instability which results from poor vital organ perfusion.

Following return of spontaneous circulation (ROSC), inability of the patient to obey commands indicates that neuroprotection techniques should be considered.



❶ Prepare the cardiac arrest trolley for any further events.

❷ Use positive pressure ventilation, aiming for:

  • SpO2 > 94% and < 98%.

  • PCO2 > 4.5 kPa and < 5.5 kPa.

❸ Give sedation and neuromuscular blocking drugs to reduce thermogenesis from shivering.

❹ Insert intra-arterial blood pressure monitoring. Consider vasopressor/inotrope to maintain systolic blood pressure, target SBP > 100 mmHg.

❺ Obtain 12-lead ECG and discuss with cardiology if percutaneous coronary intervention is possible or appropriate.

❻ Check blood glucose. Start glycaemic control therapies if above 10 mmol.l-1

❼ Check core temperature. Target temperature is a constant temperature in the range of 32 – 36°C (precise target determined by local policy):

  • Temperature usually decreases without intervention in the immediate postarrest period.

  • Start cooling strategies if indicated (Box A).

  • Avoid hyperthermia > 37.5°C.

❽ Give antiepileptic drugs if seizures develop (Box B).

❾ Plan further management in critical care area. Call for extra help as necessary.



By Association of Anaesthetists @ https://twitter.com/AAGBI

Quick Reference Handbook - Guidelines for crises in anaesthesia 



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