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ACLS Standards: Post-Cardiac Arrest Best Practices

According to the American Heart Association (AHA), 475,000 Americans die each and

every year due to cardiac arrest. What’s more, about 90% of people who experience an

out-of-hospital cardiac arrest (approximately 350,000) will lose their lives as a

result. Conversely, nearly 45% of out-of-hospital cardiac arrest victims will live,

provided bystander CPR is administered. In fact, CPR, particularly when administered

immediately after cardiac arrest, can double or even triple a person’s chance of

survival.

While the location where the cardiac arrest takes place certainly plays a role in

the chances of survival, the actions taken by someone trained in proper

resuscitation techniques can also have a life or death impact. Specifically, a

victim of cardiac arrest will have a much lower mortality risk when the individual

administering care adheres to ACLS standards. The algorithms learned in ACLS

certification, when applied in a timely and accurate manner, can dramatically

improve the chances of a positive outcome.

It’s important to point out, however that even those who do receive appropriate

treatment and survive a cardiac arrest aren’t necessarily out of the woods. While

immediate ACLS care reduces the risk of mortality, other factors could diminish the

patient’s quality of life following the event. For instance, brain damage that

occurs during cardiac arrest could result in impaired speech, mobility and memory.

This is why aftercare is equally important.

The Importance of ACLS Standards

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According to the National Center for Biotechnology Information (NCBI), the

percentage of ACLS steps adhered to by someone performing CPR is an accurate

indicator of return of spontaneous circulation (ROSC). This is true regardless of

whether the care is administered in a hospital setting or not. In fact, because

secondary medical problems are largely dependent on the time that lapses between the

onset of cardiac arrest and emergency care, positive patient outcomes are directly

associated with adherence to these ACLS standards.

In fact, with the exception of age and location, all of the remaining factors that

can negatively impact outcomes of cardiac arrest are related to the time delay

between the medical event and the initiation of care. For example, as more time

passes without blood flow, the oxygen supply to the brain and vital organs is

expended. As a result, tissue death can occur.

Adherence to ACLS standards can effectively reduce the risk of negative outcomes

associated with these time-related factors. In other words, the administration of

timely, high-quality compressions and appropriate medication can mean the difference

between life and death.

Post-Cardiac Arrest Best Practices

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Following ROSC, proper intervention can further reduce the risk of negative outcome

by limiting tissue damage and preventing additional cardiac arrest from occurring.

According to AHA guidelines, there are certain best practices that health care

professionals should follow post-cardiac arrest. These best practices are as

follows:

Cardiovascular Care

Appropriate cardiovascular care involves gathering a 12-lead EKG to ascertain ST

elevation presence, maintaining an appropriate blood pressure, administering of

vasopressors and administering a coronary angiography if necessary. It’s also

important to check for internal bleeding, conduct blood tests (CBC/CMP), and

frequently monitor vital signs. In some instances, insertion of an arterial line and

round-the-clock blood pressure monitoring may be necessary. Also, depending on the

cause of the cardiac arrest, additional interventions may be required.

Neurological Care

Brain injury contributes to loss of life in 68% of patients suffering out-of-

hospital cardiac arrest and 23% of in-hospital cardiac arrest. As such, health care

professionals should monitor for any signs of potential brain injury, such as

seizures, neurocognitive dysfunction, coma and brain death. If any of these signs

exist, brain activity should be monitored via EEG. Further, in the event of

seizures, appropriate medication may be required to reduce their occurrence and

lessen the likelihood of long-term damage.

Respiratory Care

Following cardiac arrest, a chest x-ray may be required in order to verify

appropriate ET tube placement. Monitoring of blood gases can also contribute to

improved outcomes. The AHA recommends a PaCO2 level of 35-45 mmHg. Keep in mind that

certain treatments may impact PaCO2 levels. In such instances, actual PaCO2 readings

may be skewed. Post-cardiac arrest pulmonary care should also include addressing

other factors that may have contributed to the arrest, such as breathing problems.

Treatment of Pulmonary Embolism

If the cause of the cardiac arrest has been identified as a pulmonary embolism (aka

pulmonary thrombosis), treatment should be administered as soon as possible. The AHA

recommends the administration of fibrinolytics, though hospital protocol should be

followed.

Sedation to Reduce Patient Stress

It’s common practice to intubate a patient following cardiac arrest, as doing so

ensures proper oxygen and ventilation. Sedation may be recommended to help reduce

the level of stress and agitation the patient may feel during the intubation

process. Additionally, for patients experiencing cognitive dysfunction following

cardiac arrest, intubation may help reduce the risk of self-injury.

Targeted Temperature Management

Initially, Targeted Temperature Management (TTM) – aka induced hypothermia - was

recommended only for patients who had experienced out-of-hospital ventricular

fibrillation or pulseless ventricular tachycardia for a prolonged comatose state

(more than 20 minutes). It is now believed that any cardiac arrest patient with a

non-shockable rhythm may benefit from TTM. Following at least 24 hours of TTM,

gradual rewarming to normal core temperature can begin. Sedation may be necessary

during this phase.

The goal of every health care professional treating cardiac arrest is to reduce the

long-term impact on the body for survivors as much as possible. The six best

practices above demonstrate the need to address the key body systems that can be

negatively affected by cardiac arrest. By understanding the ACLS standards and their

impact on care during and following cardiac arrest, health care professionals can

both increase the chances of survival and improve the patient’s quality of life

after the fact.

Want to make a positive impact on the lives of others? Enroll in one of our life-

saving skills courses today. Choose from Cardio Basic Life Support (BLS), Advanced

Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS) or

Cardiopulmonary Resuscitation (CPR), Automated External Defibrillator (AED) and

First Aid courses and become certified for as little as $35! Click here to learn

more.

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