MD PhD FCICM EDIC Markus Skrifvars Departement of Anaesthesiology Intensive Care and Paine medicine Helsinki University Hospital Finland SSAI Malmö 792017 Key points Oxygenation ID: 934371
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Slide1
SUMMARYWhat are the optimal paO2 and paCO2 targets during and after cardiac arrest?
MD, PhD, FCICM, EDIC Markus SkrifvarsDepartement of Anaesthesiology, Intensive Care and Paine medicineHelsinki University Hospital, Finland
SSAI Malmö 7.9.2017
Slide2Key points – Oxygenation during
CPRExperimental evidence suggests that effective chest compressions are
the most important determinant of
brain tissue
oxygenationVentilation with 100% oxygen during CPR may be
associated with hyperoxia
especially after return of
sponaneous
circulation
but
its
clinical
implications
are
unknown
The
risk
of
extreme
hyperoxia
is
likely
to
be
more
common
with
short
delay
to
start
of CPR
The
use
of 100%
oxygen
is
likely
more
relevant
with
hypoxic
arrests
that
with
arrests
with
a
cardiac
etiology
Intra-
arrest
h
yperventilation
is
detrimental
and
should
be
avoided
Slide3Key points – Immediately after
ROSCAfter ROSC the circulation is commonly hyperdynamic partly due to the
use of adrenalineAfter ROSC aim
to titrate
oxygen useContinue giving 100% oxygen only with verified
hypoxiaTitrate ventilation
according to paCO2Monitoring oxygenation and
ventilation
require
arterial
blood
gas
analysis
,
peripheral
02
saturation
monitoring
can
be
inexact
Slide4Key points – During care in
the ICU During the following hours (4-48 hours) there appears to be a decrease in blood flow with an increase in oxygen extraction in the brainCarbon dioxide is an important determinant of blood flowModerate hypercapnia may be protectiveHypoxia and hypocapnia is harmful and should be
avoidedDuring TTM hyperventilation is common, patients may require much less ventilation than anticipatedTrials are beginning looking at the value of moderate hypercapnia