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. atracurium) is required to optimise ventilation.

Seizures occur in 12-20% of post cardiac arrest patients and can cause a three-fold increase in brain metabolism. Prophylactic administration of benzodiazepines or anti-seizure medication (e.g. phenytoin) is not required but any seizures should be aggressively treated[23].

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

Tight glycaemic control is not recommended, not least because the comatose patient is at risk of undiagnosed hypoglycaemia [10].

However, hyperglycaemia has been correlated with increasing risk of poor neurological outcome [11].

Based on the available data, following ROSC, blood glucose should be maintained at <= 10 mmol/ L-1. [12].