Post-CPR Clinical Pathway — PICU and CICU | Children's Hospital of Philadelphia

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Provider Resources

Related Pathways

For infants in the N/IICU,
Neonatal Clinical Care Guideline:
Post-Cardiac Arrest Care

Child After CPR for an In-Hospital or
Out-of-Hospital Cardiac Arrest

For all CPR events, send message to:
PHL PICU CARG 1^st Contact
via Epic secure chat

TTM Targeted Temperature Management
GCS Glasgow Coma Scale
ROSC Return of Spontaneous Circulation
SBS State Behavioral Scale

Physical Exam, Calculate Glasgow Coma Scale

Baseline neurologic function
or
Motor GCS ≥ 5

Not at baseline neurologic function
due to injury, illness or ICU interventions
or
Motor GCS < 5

Critical Care Cardiac Arrest, Baseline Neurologic Function Order Set

Critical Care Cardiac Arrest, Severe/Abnormal Neurologic Function Order Set

Diagnostic Assessment

Post-Arrest Evaluation
- Laboratory Studies
- Imaging

Diagnostic Assessment

Recommended Testing and Monitoring
- Laboratory studies
- Imaging
- Hemodynamic monitoring
- Neuromonitoring
- Consults

Treatment

Maintain core temperature < 37.5°
- Minimum 48 hrs
Maintain normotension

Treatment

Clinical Goals and Vital Sign Targets
- Normotension for age
- Normoxia
- Normocapnia
- Normoglycemia
- Considerations for Children with Heart Defects
Treat seizures
Sedate to maintain SBS -1 to -2
- Consider paralytic to prevent shivering
Targeted temperature management

Out-of-hospital Arrest

In-hospital Arrest

Attending determination
at time of admission

Targeted Temperature Management 33°C

Targeted Temperature Management 36°C

Prognostic Guidance

Disposition

Posted: August 2013
Last Revised: October 2024

Authors:
- A. Topjian, MD;
- J. Fowler, MD;
- V. Nadkarni, MD;
- R. Berg, MD;
- A. Dewitt, MD;
- B. Blowey, PharmD;
- K. Lourie, RN;
- N. McGowan, RT;
- K. Agarwal, CNS;
- M. Kirschen, MD;
- N. Pinto, MD;
- M. Gardner, MD

Evidence

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

PICU and CICU Clinical Pathwayfor the Care of the Child After CPR

Evidence

PICU and CICU Clinical Pathway
for the Care of the Child After CPR