ECC Post-Resuscitation Care & Recovery 2 — Questions and Answers
Question 1: Which hemodynamic target is recommended for mean arterial pressure (MAP) in post-cardiac arrest patients to ensure adequate cerebral perfusion?
- ≥65 mmHg (Correct answer)
- ≥50 mmHg
- ≥90 mmHg
- ≥110 mmHg
Correct answer: ≥65 mmHg
Current guidelines recommend maintaining a MAP of ≥65 mmHg post-resuscitation, though some centers target higher values based on patient response.
Question 2: A post-resuscitation patient develops a temperature of 38.6°C at 18 hours. What is the recommended management according to TTM guidelines?
- Actively prevent fever with antipyretics or cooling (Correct answer)
- Allow fever to persist as it aids immune response
- Begin broad-spectrum antibiotics only
- Initiate therapeutic hypothermia to 33°C immediately
Correct answer: Actively prevent fever with antipyretics or cooling
Post-resuscitation fever is harmful to the ischemic brain, so current TTM trials support actively preventing fever (≥37.7–38°C) for at least 72 hours.
Question 3: Which arterial blood gas finding is MOST detrimental to neurological recovery in post-cardiac arrest patients?
- PaO2 of 60 mmHg (hypoxia) (Correct answer)
- PaCO2 of 40 mmHg
- pH of 7.35
- PaO2 of 100 mmHg
Correct answer: PaO2 of 60 mmHg (hypoxia)
Hypoxia (low PaO2) causes secondary brain injury and worsens neurological outcomes after cardiac arrest.
Question 4: After ROSC, a 12-lead ECG shows ST-elevation in leads II, III, and aVF. What is the recommended next step?
- Emergent coronary angiography (Correct answer)
- IV thrombolytics only
- Repeat ECG in 30 minutes
- Admit to ICU without cath lab activation
Correct answer: Emergent coronary angiography
ST-elevation after ROSC indicates likely STEMI and requires immediate coronary angiography regardless of neurological status.
Question 5: Which EEG pattern is MOST predictive of poor neurological outcome after cardiac arrest?
- Burst suppression with identical bursts (malignant pattern) (Correct answer)
- Theta-dominant background
- Alpha coma with reactivity
- Diffuse slowing without suppression
Correct answer: Burst suppression with identical bursts (malignant pattern)
Burst suppression with stereotyped (identical) bursts is a malignant EEG pattern strongly associated with poor neurological outcome.
Question 6: When is the earliest recommended time to perform neuroprognostication after cardiac arrest in a patient who received TTM?
- 72 hours after ROSC (Correct answer)
- 24 hours after ROSC
- 12 hours after ROSC
- 7 days after ROSC
Correct answer: 72 hours after ROSC
Neuroprognostication should not occur before 72 hours after ROSC to allow sedative/analgesic clearance and full neurological examination.
Question 7: Which finding on somatosensory evoked potentials (SSEPs) is a reliable predictor of poor neurological outcome post-cardiac arrest?
- Bilateral absence of N20 cortical response (Correct answer)
- Unilateral delayed N20 response
- Prolonged P25 latency bilaterally
- Normal N20 with absent N13
Correct answer: Bilateral absence of N20 cortical response
Bilateral absence of N20 cortical SSEPs is one of the most reliable predictors of poor outcome in comatose post-cardiac arrest survivors.
ECC Post-Resuscitation Care & Recovery 2
Which hemodynamic target is recommended for mean arterial pressure (MAP) in post-cardiac arrest patients to ensure adequate cerebral perfusion?