From the Guidelines
Post-cardiac arrest syndrome is associated with various arrhythmias, including ventricular tachycardia, ventricular fibrillation, bradycardia, and asystole, which require prompt management to improve morbidity, mortality, and quality of life. The management of these arrhythmias involves immediate defibrillation for ventricular tachycardia or fibrillation, followed by administration of antiarrhythmic medications such as amiodarone or lidocaine 1.
Arrhythmias Associated with PCAS
- Ventricular tachycardia
- Ventricular fibrillation
- Bradycardia
- Asystole For bradyarrhythmias, atropine can be used, with consideration for transcutaneous pacing if atropine is ineffective 1.
Management of Arrhythmias
- Immediate defibrillation for ventricular tachycardia or fibrillation
- Administration of antiarrhythmic medications such as amiodarone (300 mg IV bolus, followed by 150 mg if needed) or lidocaine (1-1.5 mg/kg IV bolus, followed by 0.5-0.75 mg/kg if needed)
- Atropine (0.5 mg IV every 3-5 minutes, maximum 3 mg) for bradyarrhythmias
- Correction of underlying causes such as electrolyte abnormalities, acid-base disturbances, and hypoxia The use of β-adrenergic–blocking drugs, such as metoprolol or bisoprolol, may be associated with improved survival rates after cardiac arrest, but their routine administration is not recommended due to potential hazards 1.
Monitoring and Treatment
- Continuous cardiac monitoring for at least 48-72 hours post-arrest
- Availability of emergency medications and defibrillation equipment at the bedside
- Correction of underlying causes of arrhythmias to improve morbidity, mortality, and quality of life.
From the Research
Arrhythmias Associated with Post-Cardiac Arrest Syndrome (PCAS)
- Atrial fibrillation
- Atrial flutter
- AV-nodal reentry tachycardia with rapid ventricular response
- Atrial ectopic tachycardia
- Preexcitation syndromes combined with atrial fibrillation or ventricular tachyarrhythmias 2
- Ventricular tachyarrhythmias, including ventricular fibrillation and ventricular tachycardia 2, 3
Management of Arrhythmias in PCAS
- Immediate DC-cardioversion is indicated in patients with unstable hemodynamics 2
- Antiarrhythmic drugs such as amiodarone, ibutilide, and sotalol can be used to convert atrial fibrillation to sinus rhythm 2, 3
- Rate-control may be an appropriate therapy in patients with recurrent atrial fibrillation after DC-cardioversion 2
- Defibrillation and advanced life support are essential for neurologic outcome in patients after cardiac arrest due to ventricular tachyarrhythmias 2
Post-Cardiac Arrest Care
- Early invasive coronary angiography should be considered to identify and treat coronary artery obstructive disease 4, 5
- Target temperature therapeutic hypothermia and strict temperature control are recommended 4
- Monitoring of electrocardiogram, oximetry, capnography, and electroencephalography (EEG) is necessary 4
- Seizure should be treated if EEG shows evidence of seizure or epileptiform activity 4