CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries CRACKCast E008 - Brain Resuscitation
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Feb 22, 2016 Discussion of post-cardiac-arrest brain care, including six immediate interventions to protect the brain. Pathophysiology of ischemic brain injury and goals of cerebral resuscitation are explored. Practical temperature management approaches and five ways to initiate therapeutic hypothermia are reviewed. Strategies to prevent secondary injury like seizure control, glucose management, and bedside protective measures are highlighted.
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Keep Post‑Arrest Physiology In Normal Ranges
- Avoid derailing the injured brain by keeping vitals and ABG values normal after ROSC.
- Maintain MAP >65, diastolic <120, PaO2 80–120, PaCO2 35–45 and treat seizures promptly to protect autoregulation.
Minimize Stimulation And Optimize Head Neck Position
- Reduce secondary brain injury by minimizing stimulation and controlling airway and neck position at the bedside.
- Keep head neutral, loosely apply C‑collar, prevent Valsalva, and sedate/paralyze with EEG if needed for monitoring.
Actively Control Temperature And Glucose
- Actively control temperature and glucose after ROSC to reduce metabolic stress on the brain.
- Use core thermometry, antipyretics, cooling if indicated, and cautiously treat marked hyperglycemia with insulin.