ACLS Resuscitation and Post-ROSC Care Quiz

ACLS Resuscitation and Post-ROSC Care Summary

• Intravenous (IV) access is the preferred route for medication administration during ACLS resuscitation, with intraosseous (IO) access as an acceptable alternative.
• Post-ROSC care involves close attention to oxygenation, blood pressure control, percutaneous coronary intervention evaluation, targeted temperature management, and neuroprognostication.
• Long-term recovery support for physical, cognitive, and psychosocial needs is necessary for cardiac arrest survivors.
• Debriefing for lay rescuers, EMS providers, and healthcare workers after resuscitation can support their mental well-being.
• Management of cardiac arrest in pregnancy focuses on maternal resuscitation and early perimortem cesarean delivery if needed.
• The ACLS guidelines include updated algorithms and visual aids for resuscitation and post-cardiac arrest care.
• New and updated recommendations include early initiation of CPR by lay rescuers and early administration of epinephrine for nonshockable and shockable rhythms.
• New evidence supports the low risk of harm from laypersons initiating CPR and the benefit of early epinephrine administration.
• Real-time audiovisual feedback devices may be reasonably used to optimize CPR performance.
• The guidelines emphasize the importance of layperson-initiated CPR and early epinephrine administration for improved outcomes in cardiac arrest.
• The ACLS guidelines provide comprehensive support for resuscitation and post-ROSC care, including specific algorithms for opioid-associated emergencies and cardiac arrest in pregnancy.
• The guidelines aim to improve survival and favorable neurologic outcomes for cardiac arrest patients through evidence-based recommendations and visual training aids.

Cardiac Arrest Guidelines 2020

• A recent RCT showed a 25% increase in survival to hospital discharge from in-hospital cardiac arrest (IHCA) with audio feedback on compression depth and recoil.
• It may be reasonable to use physiologic parameters such as arterial blood pressure or ETCO2 to monitor and optimize CPR quality.
• New data from the AHA’s Get With The Guidelines®-Resuscitation registry show higher likelihood of return of spontaneous circulation (ROSC) when CPR quality is monitored using ETCO2 or diastolic blood pressure.
• Double sequential defibrillation for refractory shockable rhythm has not been established as useful, based on a 2020 ILCOR systematic review.
• IV access is preferred over intraosseous (IO) access for drug administration in cardiac arrest, but IO access may be considered if IV access is unsuccessful or not feasible.
• Post–Cardiac Arrest Care and Neuroprognostication recommendations from the 2015 AHA Guidelines Update for CPR and ECC were reaffirmed with new supporting evidence.
• Neuroprognostication should be performed no sooner than 72 hours after return to normothermia, based on new recommendations.
• Cardiac arrest survivors should have multimodal rehabilitation assessment and treatment before discharge from the hospital, and receive comprehensive discharge planning.
• Structured assessment for anxiety, depression, posttraumatic stress, and fatigue is recommended for cardiac arrest survivors and their caregivers.
• Debriefings and referral for follow up for emotional support for lay rescuers, EMS providers, and hospital-based healthcare workers after a cardiac arrest event may be beneficial.
• The 2020 AHA guidelines emphasize the importance of support for rescuers who may experience anxiety or posttraumatic stress.
• Recovery from cardiac arrest extends beyond the initial hospitalization, requiring ongoing support for optimal physical, cognitive, and emotional well-being.