After ROSC Management

Beta Blockers

After ROSC routine use of beta-blockers is not currently recommended.  However, for patients who had cardiac arrest due to VF/pVT either initiation or continuation of either an oral or IV beta-blocker may be considered.

Lidocaine

It is reasonable use Lidocaine as an alternative antiarrhythmic to Amiodarone when circumstances make administration of Amiodarone unwise or unavailable.  Lidocaine may also, be reasonably used after ROSC to prevent recurrent VF/pVT.

Targeted Temerpature Management

Hypothermia therapy is now called Targeted Temperature Mangement TTM.  Patients who show signs of neurological impairment such as a change in LOC, are comatose, or even just unable to follow commands correctly should receive TTM.  A single target temperature between 32°C and 36°C should be chosen and maintained for 24-72 hours.  Variations in temperature up or down have been shown to be associated with poorer outcomes.  Even after 24-72 hours when the patient is returned to normal temperature efforts should be made to avoid a fever for at least 7 days, as fever during this time has been shown to be associated with poorer outcomes.

Goals for Hemodynamic status after ROSC 

After ROSC hypotension should be avoided by immediate administration via IV or IO of appropriate volume expanders.  Systolic blood pressure should be maintained at 90 mm Hg or greater and the mean arterial pressure should be maintained at 65 mm Hg.  Studies have shown that less than these pressure have been associated with negative outcomes after ROSC.  Studies have also shown that systolic pressure greater than 100 mm Hg were associated with positive outcomes after ROSC.