High quality CPR and adherence to ACLS guidelines lead to improved patient survival rates following cardiac arrest. For this reason, immediate post cardiac arrest care is now included in the American Heart Association ACLS guidelines. To maintain perfusion to vital organs and prevent brain injury a comprehensive, multidisciplinary system of care is needed. This article will describe five components to include when creating a realistic post cardiac arrest simulation for a nursing and respiratory critical care courses. 

Oxygenation

Correct placement of the endotracheal tube should be verified with a colorimetric CO2 detector and then a waveform capnography should be used. Although 100% oxygen is typically used during initial resuscitation, a functioning headwall allows the FiO2 to be titrated to maintain a pulse oximetry of 94%. The SimVS Hospital PRO allows instructors to display continuous SpO2 and EtCO2 waveforms and adjust the values in response to patient care. The SimVS ventilator settings can be adjusted in response to the patient’s arterial blood gas values, respiratory effort, minute ventilation and lung compliance. Positive end-expiratory pressure (PEEP), can even be implemented as a lung-protective strategy. 

Cardiac Function 

Continuous EKG monitoring is essential to quickly identify and treat cardiac arrhythmias. In addition, a 12 lead EKG is needed to determine if the cardiac arrest was due to STEMI, indicating the need for immediate revascularization. To avoid interrupting the simulation, instructors can upload 12 lead EKG tracings and reports to the SimVS for display at the appropriate time. If STEMI is present, a simulated Alteplase kit can be used to immediately initiate fibrinolysis therapy as an alternative to PCI. Simulated Procainamide or Amiodarone may be administered if the patient develops recurrent VT or VF. 

Hemodynamics

The SimVS monitor displays the patient’s NIBP along with the continuous arterial pressure waveform to identify and treat hypotension. Simulated Normal Saline and Lactated Ringer’s IV fluids should be administered through a Triple Lumen Central Line if possible to prevent extravasation. Simulated Norepinephrine, Dopamine and/or Dobutamine are titrated to maintain minimum SBP of 90 mm Hg or a mean arterial pressure of 65 mmHg. A closed circuit IV system allows all types of fluids to be administered without infusing them into the manikin. For small simulation labs, the Alaris Medley system enables up to four separate infusions to be given through a single Point of Care unit. 

Temperature Management

Therapeutic hypothermia is the only intervention that has been shown to improve neurologic recovery after cardiac arrest and ROSC. Cooling can be initiated with rapid infusion of ice-cold simulated Normal Saline or Lactated Ringer’s IV fluids. In addition, instructors can use any type of twin size quilt to simulate a cooling blanket. Since axillary temperatures are inadequate for hypothermia, a simulated core temperature can be displayed on the SimVS patient monitor.  

Diagnostic testing

A chest x-ray must be performed to confirm correct placement of the endotracheal tube and rule out tension pneumothorax as the cause of cardiac arrest. As with the 12 lead EKG, instructors can upload radiology films and reports for participants to review. Line Draw Plus Aspirating Syringes can be used to draw ABGs from simulated arterial lines. Frequent blood sugar assessment with a bedside glucometer like the Assure Platinum is essential because hyperglycemia is associated with increased mortality and worse neurological outcomes.

Key Takeaway 

Simulated medications and equipment from SimLabSolutions and DiaMedical USA to create engaging post cardiac arrest care scenarios for nursing and respiratory therapy students. They allow all of the essential components of care to be provided, including mechanical ventilation, therapeutic hypothermia, and coronary reperfusion. For more information about these items, reach out to a DiaMedical USA expert at 877-593-6011 or info@diamedicalusa.com.