PICU and CICU Clinical Pathway for the Care
of Children Post-CPR

Goals and Metrics
Provider Resources
  • EPIC Order Sets
  • Critical Care Cardiac Arrest,
    Baseline Neurologic Function
  • Critical Care Cardiac Arrest, Severe/Abnormal Neurologic Function
Related Pathways
For all CPR events, send message to:
PHL PICU CARG 1st Contact
via EPIC secure chat
Post-CPR Care
In-hospital or Out-of-hospital Cardiac Arrest
Definitions
TTM Targeted Temperature Management
GCS Glasgow Coma Scale
ROSC Return of Spontaneous Circulation
SBS State Behavioral Scale
Physical Examination
Calculate Glasgow Coma Scale
Critical Care Cardiac Arrest
Order Set
Motor GCS ≥ 5 or at baseline
neurologic function
Not Conscious and unsedated Motor GCS < 5
OR
Not at baseline neurologic function
(due to injury, illness or ICU interventions)
Maintain core temperature < 37.5° C
Minimum 48 hours
Recommended Post-Arrest Evaluation
Diagnostic Assessment
Recommended Testing & Monitoring
Treatment
Clinical Goals and Vital Sign Targets
Out-of-hospital Arrest
TTM up to 5 days
Admitting attending
determination at time of admission
In-hospital Arrest
TTM up to 5 days
  • Blanket temp set 33°C (Core Temp Goal 32-34°C) for 48 hours
  • Rewarm over 16-24 hours
  • Controlled normothermia (Core Temp Goal 36°C) for 48 hours
  • Sedation to maintain SBS -2 during cooling
  • Consider paralytic infusion to prevent shivering
  • Blanket temp set 36°C (Core Temp Goal 35-37°C)
  • Minimum 72 hours, up to 120 hours
  • Prevent fever and shivering
  • Sedation to maintain SBS -1
  • Consider increased sedation and/or paralytic infusion to prevent shivering
Prognostic Guidance
Disposition
Posted: August 2013
Revised: August 2022
Authors: A. Topjian, MD; L. Hutchins, MSN; V. Nadkarni, MD; R. Berg, MD; J. Blinder, MD; A. Dewitt, MD; T. Conlon, MD; J. Fowler, MD; B. Blowey, PharmD; K. Lourie, RN; K. Morris, RN; N. McGowan, RT