ACLS - Advanced Cardiovascular Life Support Post-Cardiac Arrest Care Questions and Answers — Questions and Answers
Question 1: A 58-year-old male has return of spontaneous circulation (ROSC) after a witnessed cardiac arrest. He is intubated and remains unresponsive to verbal commands. Which of the following is a primary goal for ventilation and oxygenation in the immediate post-cardiac arrest period?
- Maintain SpO2 at 100% to maximize cerebral oxygen delivery.
- Titrate FiO2 to maintain SpO2 between 92% and 98%. (Correct answer)
- Induce hypocapnia by hyperventilating the patient to a PaCO2 of 25-30 mmHg.
- Set the ventilator to 20 breaths per minute to ensure adequate minute ventilation.
Correct answer: Titrate FiO2 to maintain SpO2 between 92% and 98%.
In post-cardiac arrest care, both hypoxia and hyperoxia can be harmful. The goal is to titrate the fraction of inspired oxygen (FiO2) to achieve an arterial oxygen saturation (SpO2) between 92% and 98%. Maintaining 100% SpO2 can lead to oxygen toxicity and is not recommended. Hyperventilation causing hypocapnia leads to cerebral vasoconstriction, reducing blood flow to the brain. Excessive ventilation rates can also cause adverse hemodynamic effects.
Question 2: Following ROSC, a patient is found to be hypotensive with a blood pressure of 80/50 mmHg. According to ACLS guidelines, what is the initial mean arterial pressure (MAP) target for hemodynamic support?
- Greater than 80 mmHg
- Less than 60 mmHg
- Greater than or equal to 65 mmHg (Correct answer)
- Exactly 70 mmHg
Correct answer: Greater than or equal to 65 mmHg
The primary hemodynamic goal in post-cardiac arrest care is to maintain adequate systemic and cerebral perfusion. ACLS guidelines recommend treating hypotension to maintain a mean arterial pressure (MAP) of 65 mmHg or greater. This is typically achieved with intravenous fluids, vasopressors, and/or inotropes.
Question 3: Which of the following is the most appropriate indication for initiating Targeted Temperature Management (TTM) in a patient who has achieved ROSC?
- The patient is awake and following commands but has a fever.
- The patient had a cardiac arrest with an initial rhythm of asystole.
- The patient is comatose and not following verbal commands. (Correct answer)
- The patient has a history of neurological disease.
Correct answer: The patient is comatose and not following verbal commands.
Targeted Temperature Management (TTM) is indicated for adult patients who remain comatose (i.e., do not follow verbal commands) after achieving ROSC, regardless of the initial rhythm. The goal of TTM is to improve neurological outcomes by preventing fever and reducing cerebral metabolic demand.
Question 4: A patient with ROSC after a VF arrest has a 12-lead ECG that shows ST-segment elevation. Which of the following interventions should be considered a high priority?
- Administering a bolus of amiodarone
- Obtaining a CT scan of the head
- Immediate transport for coronary angiography (Correct answer)
- Starting a therapeutic hypothermia protocol at 30°C
Correct answer: Immediate transport for coronary angiography
ST-segment elevation on a post-ROSC ECG is highly suggestive of an acute coronary occlusion (STEMI) as the cause of the arrest. Emergent coronary angiography and percutaneous coronary intervention (PCI) are critical to restore blood flow and improve outcomes. While other post-arrest care is important, revascularization is a time-sensitive priority in this scenario.
Question 5: When managing a post-cardiac arrest patient who is comatose, what is the recommended target range for PaCO2 (partial pressure of carbon dioxide in arterial blood)?
- 25-30 mmHg
- 30-35 mmHg
- 50-55 mmHg
- 35-45 mmHg (Correct answer)
Correct answer: 35-45 mmHg
The recommended target for PaCO2 in post-cardiac arrest care is normocapnia, which is a range of 35-45 mmHg. Hypocapnia (low PaCO2) can cause cerebral vasoconstriction and reduce cerebral blood flow, while significant hypercapnia (high PaCO2) can increase intracranial pressure. Both extremes should be avoided.
Question 6: You are managing a patient post-ROSC who remains comatose. You have initiated targeted temperature management. Which of the following is a key component of continued management for this patient?
- Administering prophylactic antibiotics to all patients.
- Routinely inducing a barbiturate coma.
- Continuous EEG monitoring to detect seizures. (Correct answer)
- Maintaining a blood glucose level above 200 mg/dL.
Correct answer: Continuous EEG monitoring to detect seizures.
Seizures, including non-convulsive seizures, are common in comatose post-cardiac arrest patients and can contribute to secondary brain injury. Continuous EEG monitoring is recommended to detect and treat seizure activity promptly. Prophylactic antibiotics are not routinely recommended, and hyperglycemia should be avoided.
