Pitfalls
- All critically-ill patients demand physician presence at the bedside so that rapid reassessment of clinical response to interventions can be made. They cannot be managed ‘from afar’.
- Post-arrest patients have a conflicting need to perfuse the post-ischaemic brain without too much strain on the post-ischaemic heart.
- The need for adequate sedation must be balanced against the risk of worsening cardiovascular instability.
- An unconscious patient is at great risk of unrecognised hypoglycaemia, so cautious glycaemic control is preferred.
- Pyrexia is common post-arrest and must be avoided it correlates with a worse neurological outcome.
- Absent pupillary reflexes and absent motor response to pain are of no prognostic value soon after ROSC (but are of value at 72 hours).
- Advanced age does NOT predict poorer neurological outcome in patients with ROSC post-cardiac arrest.
- a pH lower than 7.05 is associated with a worse outcome post-ROSC.
- The perception of a poor outcome being likely may well affect the resuscitative teams’ efforts and become a ‘self-fulfilling prophecy’.