Disability and Glucose Control

Disability

Record the Glasgow coma scale (GCS) prior to administering any sedation – it has implications for prognostication.

If the patient is making inadequate respiratory effort or ‘fighting’ the ventilator then deepening of sedation and/or administration of neuromuscular blockade (e.g. Rocuronium) is required to optimise ventilation.

Seizures occur in 20-30% of post cardiac arrest patients and can cause a three-fold increase in brain metabolism. Routine seizure prophylaxis is not recommended in post-cardiac arrest patients, but any seizures that do occur should be treated aggressively. First line treatments are Levetiracetam or Sodium Valproate. [4]

Short-acting sedating agents are preferred (e.g. propofol) as neurological assessment can be made sooner after a sedation hold [5].

Caution with sedation; most agents can worsen cardiovascular instability.

Glucose control [6]

Tight glycaemic control is not recommended, not least because the comatose patient is at risk of undiagnosed hypoglycaemia. However, hyperglycaemia has been correlated with increasing risk of poor neurological outcome.

Based on the available data, following ROSC, blood glucose should be maintained at <= 10 mmol/ L-1.