ALS Aftercare
Apr 08, 2024![](https://kajabi-storefronts-production.kajabi-cdn.com/kajabi-storefronts-production/file-uploads/blogs/2147545446/images/00da8cf-060-40c8-e84f-5d7728014da_8.png)
ALS aftercare refers to the management of the patient after return of spontaneous circulation with the goal of avoiding secondary injury, preventing rearrest and ensuring appropriate communication between teams and with the patient’s family. β€οΈ
Here’s our guide to ALS aftercare based on ANZCOR’s recommendations: ππ
A: Airway, Access, Anaesthesia
ππΌ Confirm ETT position with ETCO2 & chest X-ray
ππΌ Prepare for intubation if required
ππΌ Ensure adequate depth of anaesthesia
ππΌ Prepare for arterial & CVC insertion (or confirm position if in situ)
B: Breathing
ππΌCheck O2 (Aim SpO2 92-96%) and CO2 (35-40mmHg) with arterial blood gas
ππΌ Suspect rib fractures from chest compressions
ππΌ Most patients will remain ventilated following intraoperative arrest
C: Circulation
ππΌ Cath lab:
πΊ Urgent referral to cardiac cath lab if a cardiac cause was suspected
ππΌ Antiarrhythmics:
πΊ Ensure a 12-lead ECG is performed when possible
πΊ Consider continuation of antiarrhythmic therapy if it was used to successfully treat the cause of arrest
πΊ If a shockable rhythm was defibrillated without the use of antiarrhythmic agents, antiarrhythmic drugs may be considered to prevent recurrent VF
ππΌ Blood pressure targets:
πΊ Vasopressors should be used if required to achieve a systolic blood pressure >100mmHg or tailored to the patient’s individual situation.
D: Disability & Destination planning
ππΌ Blood glucose and temperature should be kept within normal ranges
ππΌ Active cooling is only recommended in some out-of-hospital arrest patients
ππΌ Ensure ICU is aware, or make arrangements for interhospital transfer if required.
E: Evaluate cause
ππΌ Ensure reversible causes are addressed using 4 H’s & 4 T’s
ππΌ Remember that multiple causative factors can be present.
F: Family discussion
ππΌEnsure open disclosure with the family and patient if appropriate, in line with your hospital’s guidelines.
G: Group debriefing
ππΌ Offer a hot debrief using ANZCA’s IRASTT framework (see Nov 2023 Live Series on Debriefing)
ππΌThis allows all team members to understand the events, ask questions, identify system issues and improve team performance.
Build knowledge β
Improve safety β
Ref: https://www.anzcor.org/home/adult-advanced-life-support/guideline-11-7-post-resuscitation-therapy-in-adult-advanced-life-support/