ECC Post-Resuscitation Care & Recovery 3 — Questions and Answers
Question 1: A post-cardiac arrest patient on mechanical ventilation develops PaO2 of 250 mmHg on FiO2 1.0. What adjustment should be made?
- Titrate FiO2 down to target SpO2 94–98% (Correct answer)
- Maintain FiO2 1.0 to maximize oxygen delivery
- Increase PEEP to improve oxygenation
- Switch to high-flow nasal cannula
Correct answer: Titrate FiO2 down to target SpO2 94–98%
Hyperoxia (PaO2 >300 mmHg) is associated with worse outcomes; FiO2 should be titrated to maintain SpO2 between 94–98%.
Question 2: Which vasopressor is the first-line agent for post-resuscitation shock unresponsive to fluid resuscitation?
- Norepinephrine (Correct answer)
- Vasopressin alone
- Dopamine
- Phenylephrine
Correct answer: Norepinephrine
Norepinephrine is the preferred first-line vasopressor for post-resuscitation hemodynamic support due to its combined alpha and beta adrenergic effects.
Question 3: A post-cardiac arrest patient has persistent coma at 72 hours. What is the MOST appropriate immediate action?
- Perform a standardized multimodal neuroprognostication assessment (Correct answer)
- Withdraw life support based on coma alone
- Obtain immediate MRI only
- Administer naloxone to reverse any opioid effect
Correct answer: Perform a standardized multimodal neuroprognostication assessment
Persistent coma at 72 hours warrants a structured multimodal assessment combining clinical exam, EEG, SSEPs, and neuroimaging before any prognostic conclusions.
Question 4: Which metabolic derangement is MOST commonly associated with post-resuscitation myocardial dysfunction?
- Lactic acidosis from low cardiac output (Correct answer)
- Hyperkalemia from hemolysis
- Hyponatremia from SIADH
- Hyperglycemia from catecholamine release
Correct answer: Lactic acidosis from low cardiac output
Post-resuscitation myocardial dysfunction reduces cardiac output, leading to inadequate tissue perfusion and lactic acidosis.
Question 5: What glucose target is recommended during post-resuscitation care to balance hypoglycemia risk and hyperglycemia harm?
- 140–180 mg/dL (Correct answer)
- 80–110 mg/dL
- >200 mg/dL
- <80 mg/dL
Correct answer: 140–180 mg/dL
Current AHA guidelines recommend targeting blood glucose of 140–180 mg/dL, avoiding both hypoglycemia and extreme hyperglycemia.
Question 6: Brain CT imaging at 24–48 hours post-cardiac arrest showing diffuse cerebral edema with loss of gray-white differentiation indicates:
- Severe anoxic brain injury with poor prognosis (Correct answer)
- Normal post-arrest finding that will resolve
- Subdural hematoma requiring neurosurgical consultation
- Reversible metabolic encephalopathy
Correct answer: Severe anoxic brain injury with poor prognosis
Loss of gray-white differentiation with diffuse edema on CT represents severe hypoxic-ischemic encephalopathy and strongly predicts poor neurological outcome.
Question 7: Which intervention has been shown to IMPROVE survival to hospital discharge in post-cardiac arrest patients with cardiogenic shock?
- Coronary angiography and PCI for culprit lesion (Correct answer)
- Routine intra-aortic balloon pump placement
- Early intravenous amiodarone infusion
- High-dose methylprednisolone
Correct answer: Coronary angiography and PCI for culprit lesion
Emergent coronary angiography with PCI of the culprit lesion improves survival when an acute coronary syndrome is the likely arrest cause.
ECC Post-Resuscitation Care & Recovery 3
A post-cardiac arrest patient on mechanical ventilation develops PaO2 of 250 mmHg on FiO2 1.0.
What adjustment should be made?