Prevention of Neurological Complications Post-Cardiac Arrest
Updated: Nov 8, 2021
Cardiac arrest occurs when the heart suddenly stops beating. Cardiac arrests can occur for several reasons including:
- Abnormal electrical heart activity
- Scarring or thickening of the heart tissue
-Coronary artery disease
-Valvular heart disease
When a cardiac arrest event occurs, it is crucial to start cardiopulmonary resuscitation (CPR) immediately to get blood flow to the brain and other organs. If a cardiac arrest event occurs in the hospital setting, Advanced Cardiac Life Support (ACLS) can be initiated to provide medications with additional interventions to help the patient achieve Return of Spontaneous Circulation (ROSC) as soon as possible to minimize damage to the brain and other organs.
If ROSC is achieved it is crucial that interventions are placed immediately to prevent neurological demise. One such intervention that should be used is call Targeted Temperature Management (TTM).
TTM involves cooling the patient to a specific temperature between 33 to 37.5°C to preserve neurological function. It is used for patients that do not have initial purposeful neurologic activity on examination. TTM should begin as soon as possible after return of spontaneous circulation. The rationale behind using TTM after a cardiac arrest event is that fever is harmful to the brain.
TTM has 3 phases:
1. Initiation – starting as soon as possible after ROSC (within minutes to hours)
2. Maintenance – keeping TTM on the patient for at least 24 hours
3. Rewarming – warming the patient after TTM is complete
How is Targeted Temperature Management Performed?
Targeted temperature management can be done in several ways:
1. A water and/or air-circulating blanket and water-circulating gel-coated pads
2. Intravascularly using an intravascular cooling catheter
3. Rapid infusion of cold saline and ice packs when automated cooling devices are not available or patient needs transportation to a TTM capable facility
How is a patient rewarmed?
It is suggested to slowly rewarm patients who are under TTM by raising the temperature at a rate of 0.25 to 0.5°C per hour until normothermic. By slowly rewarming the patient we are avoiding rapid fluxes in metabolic rates and plasma electrolyte concentrations, thereby avoiding high potassium levels (which can affect heart function), seizures, and swelling in the brain.
It is also recommended to avoid fever during the rewarming phase, and for 48 hours after to decrease the risk of neurological effects related to hyperthermia.
By using Target Temperature Management evidence has shown that it can reduce the risk of long-term neurological complications and/or decrease the degree of neurological deficits, thereby improving patient outcomes.
If you have a case involving the improper treatment post cardiac arrest, contact Weiser Nurse Consulting. We can help review the case and identify possible breaches in standard of care.