ALS Aftercare

als als aftercare anzcor debriefing patient safety Apr 08, 2024
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. ❀️
 
Here’s our guide to ALS aftercare based on ANZCOR’s recommendations: πŸ‘‡πŸ‘‡
 
A: Airway, Access, Anaesthesia
πŸ‘‰πŸΌ Confirm ETT position with ETCO2 & chest X-ray
πŸ‘‰πŸΌ Prepare for intubation if required
πŸ‘‰πŸΌ Ensure adequate depth of anaesthesia
πŸ‘‰πŸΌ Prepare for arterial & CVC insertion (or confirm position if in situ)
 
B: Breathing
πŸ‘‰πŸΌCheck O2 (Aim SpO2 92-96%) and CO2 (35-40mmHg) with arterial blood gas
πŸ‘‰πŸΌ Suspect rib fractures from chest compressions
πŸ‘‰πŸΌ Most patients will remain ventilated following intraoperative arrest
 
C: Circulation
πŸ‘‰πŸΌ Cath lab:
πŸ”Ί Urgent referral to cardiac cath lab if a cardiac cause was suspected
πŸ‘‰πŸΌ Antiarrhythmics:
πŸ”Ί Ensure a 12-lead ECG is performed when possible
πŸ”Ί Consider continuation of antiarrhythmic therapy if it was used to successfully treat the cause of arrest
πŸ”Ί If a shockable rhythm was defibrillated without the use of antiarrhythmic agents, antiarrhythmic drugs may be considered to prevent recurrent VF
πŸ‘‰πŸΌ Blood pressure targets:
πŸ”Ί 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
πŸ‘‰πŸΌ Blood glucose and temperature should be kept within normal ranges
πŸ‘‰πŸΌ Active cooling is only recommended in some out-of-hospital arrest patients
πŸ‘‰πŸΌ Ensure ICU is aware, or make arrangements for interhospital transfer if required.
 
E: Evaluate cause
πŸ‘‰πŸΌ Ensure reversible causes are addressed using 4 H’s & 4 T’s
πŸ‘‰πŸΌ Remember that multiple causative factors can be present.
 
F: Family discussion
πŸ‘‰πŸΌEnsure open disclosure with the family and patient if appropriate, in line with your hospital’s guidelines.
 
G: Group debriefing
πŸ‘‰πŸΌ Offer a hot debrief using ANZCA’s IRASTT framework (see Nov 2023 Live Series on Debriefing)
πŸ‘‰πŸΌThis allows all team members to understand the events, ask questions, identify system issues and improve team performance.
 
Build knowledge βœ…
Improve safety βœ…
 
Ref: https://www.anzcor.org/home/adult-advanced-life-support/guideline-11-7-post-resuscitation-therapy-in-adult-advanced-life-support/

 

 

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