Protocol 2-704 - Post Resuscitation

EMR:

Ensure Palpable Central Pulses (Carotid and/or Femoral)

If no pulse begin compressions and return to Cardiac Arrest protocol.

Establish and maintain airway and ventilate with Oxygen.

Avoid hyperventilation.
Attempt to maintain SpO2 between 92-98%.

Apply Cardiac Monitor Combo Pads and limb leads.

EMT:

Ensure Palpable Central Pulses

Ensure completion of applicable items above.

Assist ALS with Capnography. Maintain capnography between 35-34 to guide ventilations.

Capnography greater than 45 = ventilate at faster rate

Capnography less than 35 = ventilate at slower rate

Sudden drop in Capnography = Ensure Palpable Central Pulses. If no pulse begin compressions and return to Cardiac Arrest protocol.

RN:

Ensure completion of all applicable items above.

Obtain 12-Lead ECG.

Treat rate and rhythm per protocol.

Secure airway, if necessary.

Hypotensive:

Consider IO NS/LR.
Refer to Protocol 2-583 - Hypotension / Shock.

Continued sedation: Refer to continued sedation section of Protocol 2-044 - Airway: RSI.

Consider remaining on scene for at least ten (10) minutes after ROSC to stabilize the patient before initiating transport.

CP:

Ensure completion of all applicable items above.

NEMSIS Protocol: 9914019 - Cardiac Arrest-Post Resuscitation Care

Citations:

Protocol 9-010 - References
American Heart Association, 2020
NASEMSO Medical Directors Council, 2017
Sukovaty, 2021

Change Log:

Date	Link to previous version	Description of change
12/12/14	pdf	Added consider RSI and cooling.
07/22/16	pdf	Moved NS fluid bolus if hypotension and clear lung sounds to AEMT section.
08/24/17	pdf	Removed Ativan.
09/20/17		Modified pediatric Versed dosages.
11/11/17	pdf	Replaced Versed and Fentanyl with reference to Protocol 6-050 - Control of Pain for pre-cardioversion.
08/24/18	pdf	Added comment to consider remaining on scene to stabilize for ten minutes after ROSC.
04/05/20	pdf	Added content (without substantive modification) from old Protocol 2-060 - Post Resuscitative Care.
02/19/21	pdf	AHA 2020 changes to this protocol include a slight adjustment to targeted SpO2 on the conscious ROSC patient and comments indicating a target MAP of greater than 65 should be maintained on these patients.
06/06/21	pdf	Moved to emsprotocols.online
10/15/21	pdf	Moved fluid bolus and dopamine to new hypotension protocol (2-583). This was approved by protocol committee on 5/26/21. Additionally, protocol committee approved adding push dose epi to post resuscitation on 5/26/21. Dr. Nicholes approved push-dose epi on 6/8/21. Push dose epi was added to new hypotension protocol, not post resuscitation, but is available for those type of patients.
02/25/22	pdf	Adjusted targeted temperature management details (removed cold IV and added cold pack locations). Per research done by paramedic student Megan Sukovaty and presentation made on 12/9/21, cold IV fluids cause worse outcomes. Approved by protocol committee on 1/26/22 to conform to recommendations by Sukovaty.
03/16/23	pdf	Clarified RN and medic roles. Added CP.
03/17/23		Updated links to NS.
03/19/23		Changed links for LR.

CMH Pre-Hospital Services Mission: "Provide safe, exceptional, and compassionate care to our communities with an emphasis on highly trained and empowered staff."

CMH Mobile Integrated Healthcare Mission: "Provide exceptional, compassionate, and patient-centered care by a mobile collaborative team to improve patient experience, improve quality outcomes, and reduce healthcare costs."

Protocol 2-704 - Post Resuscitation

EMD:

EMR:

EMT:

AEMT:

RN:

Medic:

CP:

Citations:

Change Log: