ACLS Post-Cardiac Arrest Care 4 — Questions and Answers
Question 1: Which EEG pattern in a post-cardiac arrest patient is most strongly associated with poor neurological prognosis?
- Burst suppression with identical bursts (generalized suppression pattern) (Correct answer)
- Diffuse theta slowing
- Reactive background with sleep-wake cycles
- Alpha frequency activity in the posterior regions
Correct answer: Burst suppression with identical bursts (generalized suppression pattern)
Burst suppression with identical bursts (suppression-burst ratio >50%) is a malignant EEG pattern indicating severe cortical injury post-arrest.
Question 2: During targeted temperature management, a patient develops bradycardia at a rate of 48 bpm with stable blood pressure. What is the most appropriate action?
- Continue TTM; bradycardia is an expected physiologic response to cooling (Correct answer)
- Administer atropine 0.5 mg IV immediately
- Terminate TTM and rewarm the patient
- Initiate transcutaneous pacing
Correct answer: Continue TTM; bradycardia is an expected physiologic response to cooling
Bradycardia during TTM is a normal physiological response to hypothermia and does not require treatment as long as hemodynamics remain stable.
Question 3: What is the recommended rewarming rate during the rewarming phase of targeted temperature management?
- 0.25°C per hour (Correct answer)
- 1°C per hour
- 2°C per hour
- As fast as possible to reach normothermia quickly
Correct answer: 0.25°C per hour
Slow controlled rewarming at 0.25°C/hour minimizes risks of hemodynamic instability, seizures, and electrolyte shifts associated with rapid temperature changes.
Question 4: NSE (neuron-specific enolase) levels greater than 60 μg/L at 48–72 hours post-arrest indicate:
- High likelihood of poor neurological outcome when combined with other predictors (Correct answer)
- Certain brain death requiring withdrawal of care
- Normal neuronal turnover and no prognostic significance
- Artifact requiring repeat testing after normothermia
Correct answer: High likelihood of poor neurological outcome when combined with other predictors
Elevated NSE is a biomarker of neuronal injury; levels >60 μg/L combined with other clinical findings support a poor prognosis but should not be used in isolation.
Question 5: Post-arrest hyperthermia (temperature >37.7°C) in the 48 hours after ROSC is associated with:
- Worse neurological outcomes due to increased cerebral metabolic demand (Correct answer)
- Improved immune response and faster recovery
- No significant clinical effect on outcome
- Reduced cerebral edema due to fever-induced osmosis
Correct answer: Worse neurological outcomes due to increased cerebral metabolic demand
Fever after cardiac arrest increases cerebral metabolic demand and excitotoxicity, worsening neurological injury and outcomes.
Question 6: Which factor is NOT a contraindication to emergent coronary angiography in a post-cardiac arrest patient?
- Coma without return of purposeful movement (Correct answer)
- Known non-cardiac cause of arrest (e.g., drug overdose)
- Confirmed terminal illness with prior DNR
- Patient's refusal prior to arrest
Correct answer: Coma without return of purposeful movement
Coma alone is not a contraindication to cardiac catheterization; post-arrest patients are routinely taken to the cath lab while comatose when a cardiac cause is suspected.
Question 7: Which medication should be avoided for seizure prophylaxis in post-cardiac arrest patients according to current evidence?
- Routine prophylactic anticonvulsants in all post-arrest patients (Correct answer)
- Levetiracetam for treatment of confirmed seizures
- Valproate for refractory status epilepticus
- Midazolam for acute seizure termination
Correct answer: Routine prophylactic anticonvulsants in all post-arrest patients
Routine prophylactic anticonvulsant use in all post-arrest patients is not recommended; treatment should be reserved for confirmed seizure activity.
ACLS Post-Cardiac Arrest Care 4
Which EEG pattern in a post-cardiac arrest patient is most strongly associated with poor neurological prognosis?