CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries CRACKCast E009 - Adult Resuscitation
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Feb 24, 2016 They break down causes of non‑traumatic cardiac arrest and what to look for when investigating why someone arrested. Clear focus on time to defibrillation and the components of high‑quality CPR. Practical ways to monitor CPR effectiveness and objective perfusion markers are discussed. Actionable post‑resuscitation physiological targets and a simple post‑arrest checklist are presented.
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Use EtCO2 And Hemodynamics To Gauge CPR Quality
- EtCO2 ≥10 mmHg indicates at least adequate CPR and rising EtCO2 can signal ROSC, but changes can be misleading after interventions.
- Rosen's recommends target EtCO2 ≈20 mmHg for strong CPR; use art line diastolic pressure and ScvO2 as additional measures.
Post-ROSC Hemodynamic And Temperature Targets
- After ROSC aim MAP 70–90 mmHg, CVP 10–15, hemoglobin >100 g/L, lactate <2, and avoid fever (target ≤36°C per newer guidance).
- Use sedation/paralysis to prevent shivering during therapeutic hypothermia and rewarm gradually.
Consider Contraindications Before Cooling Post-Arrest
- Avoid therapeutic hypothermia in severe cardiogenic shock, uncontrolled bleeding, pregnancy, coagulopathy, ESRD, drug overdose, or status epilepticus.
- Decide temperature target (32–34°C vs 36°C) per local protocol and prevent fever.