Management of Cardiac Arrest due to Thyroid Storm

Immediate Resuscitation

The American Heart Association recommends continuing high-quality CPR with chest compressions at 100-120/min, depth at least 2 inches, allowing complete chest recoil between compressions 1, 2
The American Heart Association suggests minimizing interruptions in chest compressions; rotate compressors every 2 minutes to maintain effectiveness 1, 3
The American Heart Association advises providing ventilation at 1 breath every 6 seconds (10 breaths/min) once advanced airway is placed, with continuous chest compressions 1, 4
The American College of Cardiology recommends establishing IV/IO access immediately for medication administration 1, 3
The American College of Cardiology suggests administering epinephrine 1 mg IV/IO every 3-5 minutes during resuscitation 1, 3
The American College of Cardiology advises defibrillating shockable rhythms (VF/pVT) with biphasic 120-200 joules, resuming CPR immediately after each shock 1, 3
The American College of Cardiology recommends considering amiodarone 300 mg IV bolus for refractory VF/pVT, with second dose of 150 mg if needed 1, 3

The American Thyroid Association recommends administering Saturated Solution of Potassium Iodide (SSKI) 5 drops every 6 hours, which blocks thyroid hormone release; must give after thionamide to prevent substrate for new hormone synthesis 3
The American Thyroid Association suggests administering Hydrocortisone 100 mg IV every 8 hours, which blocks peripheral T4 to T3 conversion and treats potential relative adrenal insufficiency 3

The American College of Cardiology recommends maintaining MAP >80 mmHg or systolic BP >100 mmHg to ensure adequate cerebral and coronary perfusion 5
The American College of Cardiology suggests using norepinephrine as the preferred vasopressor if needed for blood pressure support 5

The Society of Critical Care Medicine recommends continuous cardiac monitoring for arrhythmias (atrial fibrillation common) 5
The Society of Critical Care Medicine suggests continuous temperature monitoring with active cooling measures for hyperthermia 5
The Society of Critical Care Medicine advises maintaining arterial line for continuous blood pressure monitoring and frequent blood gas sampling 5
The Society of Critical Care Medicine recommends central venous access for vasopressor/inotrope administration 5

The American Heart Association recommends targeted temperature management 32-34°C for 24 hours in comatose survivors post-ROSC 5, 6
The American Heart Association suggests avoiding hyperthermia as it worsens neurological outcomes 5
The American Heart Association advises maintaining adequate intravascular volume while avoiding excessive fluid that worsens pulmonary edema 5
The American Heart Association recommends correcting electrolyte abnormalities aggressively (potassium, magnesium, calcium) 5
The American Heart Association suggests maintaining normoglycemia (avoid both hyper- and hypoglycemia) 5

The American Academy of Neurology recommends not prognosticating neurological outcome before 72 hours post-ROSC, especially with therapeutic hypothermia 6
The American Academy of Neurology suggests using a multimodal approach including clinical exam, neurophysiology, imaging, and biomarkers after 72 hours 6