CPR Post-Cardiac Arrest Care 3 — Questions and Answers
Question 1: Which organ system is most vulnerable to ischemia-reperfusion injury following cardiac arrest and ROSC?
- Brain (Correct answer)
- Liver
- Skeletal muscle
- Pancreas
Correct answer: Brain
The brain is exquisitely sensitive to ischemia-reperfusion injury due to its high metabolic demand and limited glycogen stores.
Question 2: What ventilator setting change should be made if a post-arrest patient's PaCO2 is 30 mmHg?
- Decrease respiratory rate or tidal volume to raise PaCO2 (Correct answer)
- Increase FiO2 immediately
- Add PEEP to improve oxygenation
- Switch to pressure-control ventilation
Correct answer: Decrease respiratory rate or tidal volume to raise PaCO2
Hypocarbia causes cerebral vasoconstriction; the target PaCO2 is 35–45 mmHg, so ventilation must be reduced to correct hypocapnia.
Question 3: In a comatose post-cardiac arrest patient, pupillary light reflex absence at 72 hours after normothermia is considered a predictor of what outcome?
- Poor neurological outcome (Correct answer)
- Full neurological recovery
- Moderate disability only
- Brainstem hyperactivity
Correct answer: Poor neurological outcome
Bilateral absence of pupillary light reflexes at ≥72 hours post-arrest is a reliable prognostic marker of poor neurological outcome per AHA guidelines.
Question 4: Which medication class is used to suppress shivering during targeted temperature management without causing significant hemodynamic depression?
- Magnesium sulfate (Correct answer)
- Beta-blockers
- Calcium channel blockers
- Antiepileptics
Correct answer: Magnesium sulfate
Magnesium sulfate raises the shivering threshold and is commonly used as a first-line anti-shivering agent with minimal cardiovascular effects.
Question 5: A ROSC patient has a blood glucose of 220 mg/dL. What is the AHA-recommended management approach?
- Treat hyperglycemia but avoid hypoglycemia; target 144–180 mg/dL (Correct answer)
- Administer insulin to achieve strict euglycemia (<110 mg/dL)
- No treatment needed unless >300 mg/dL
- Give dextrose to stabilize glucose around 200 mg/dL
Correct answer: Treat hyperglycemia but avoid hypoglycemia; target 144–180 mg/dL
Current guidelines recommend treating hyperglycemia to a target of 144–180 mg/dL while carefully avoiding hypoglycemia, which is equally harmful.
Question 6: What is the recommended duration of targeted temperature management (TTM) at the goal temperature?
- 24–48 hours (Correct answer)
- 6–12 hours
- 72–96 hours
- 12–18 hours
Correct answer: 24–48 hours
Current evidence and AHA guidelines support maintaining TTM at the target temperature for 24–48 hours before initiating controlled rewarming.
Question 7: During post-arrest care, which parameter best guides fluid resuscitation beyond initial boluses?
- Dynamic measures of preload responsiveness (e.g., pulse pressure variation) (Correct answer)
- Static CVP measurement alone
- Heart rate trend only
- Urine output target of >30 mL/hr alone
Correct answer: Dynamic measures of preload responsiveness (e.g., pulse pressure variation)
Dynamic indices like pulse pressure variation or stroke volume variation are superior to static CVP in predicting fluid responsiveness.
CPR Post-Cardiac Arrest Care 3
Which organ system is most vulnerable to ischemia-reperfusion injury following cardiac arrest and ROSC?