ALS Aftercare

als als aftercare anzcor debriefing patient safety Apr 08, 2024
ALS aftercare refers to the management of the patient after return of spontaneous circulation with the goal of avoiding secondary injury, preventing rearrest and ensuring appropriate communication between teams and with the patient’s family. ❤️
 
Here’s our guide to ALS aftercare based on ANZCOR’s recommendations: 👇👇
 
A: Airway, Access, Anaesthesia
👉🏼 Confirm ETT position with ETCO2 & chest X-ray
👉🏼 Prepare for intubation if required
👉🏼 Ensure adequate depth of anaesthesia
👉🏼 Prepare for arterial & CVC insertion (or confirm position if in situ)
 
B: Breathing
👉🏼Check O2 (Aim SpO2 92-96%) and CO2 (35-40mmHg) with arterial blood gas
👉🏼 Suspect rib fractures from chest compressions
👉🏼 Most patients will remain ventilated following intraoperative arrest
 
C: Circulation
👉🏼 Cath lab:
🔺 Urgent referral to cardiac cath lab if a cardiac cause was suspected
👉🏼 Antiarrhythmics:
🔺 Ensure a 12-lead ECG is performed when possible
🔺 Consider continuation of antiarrhythmic therapy if it was used to successfully treat the cause of arrest
🔺 If a shockable rhythm was defibrillated without the use of antiarrhythmic agents, antiarrhythmic drugs may be considered to prevent recurrent VF
👉🏼 Blood pressure targets:
🔺 Vasopressors should be used if required to achieve a systolic blood pressure >100mmHg or tailored to the patient’s individual situation.
 
D: Disability & Destination planning
👉🏼 Blood glucose and temperature should be kept within normal ranges
👉🏼 Active cooling is only recommended in some out-of-hospital arrest patients
👉🏼 Ensure ICU is aware, or make arrangements for interhospital transfer if required.
 
E: Evaluate cause
👉🏼 Ensure reversible causes are addressed using 4 H’s & 4 T’s
👉🏼 Remember that multiple causative factors can be present.
 
F: Family discussion
👉🏼Ensure open disclosure with the family and patient if appropriate, in line with your hospital’s guidelines.
 
G: Group debriefing
👉🏼 Offer a hot debrief using ANZCA’s IRASTT framework (see Nov 2023 Live Series on Debriefing)
👉🏼This allows all team members to understand the events, ask questions, identify system issues and improve team performance.
 
Build knowledge ✅
Improve safety ✅
 
Ref: https://www.anzcor.org/home/adult-advanced-life-support/guideline-11-7-post-resuscitation-therapy-in-adult-advanced-life-support/

 

 

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