Postresuscitation care

• Airway: Secure the airway in comatose patients with early placement of an endotracheal tube.

• Target respiratory parameters: Titrate FiO2 and initiate waveform capnography.

  • Respiratory rate: Start at 10 breaths/minute.

  • Titrate oxygen therapy to reach SpO2 of 92–98% and PaCO2 of 35–45 mm Hg.

• Target hemodynamic parameters: Administer IV fluids as needed and consider vasopressors and/or inotropes.

  • Systolic blood pressure > 90 mm Hg

  • Mean arterial pressure > 65 mm Hg

• Obtain 12-lead ECG: to elevate for acute ST-segment elevation

• Address the cause of arrest:

• Start targeted temperature management (TTM): Aim for a body temperature of 32–36°C for at least 24 hours

• Initiate other neuroprotective measures

• Admit to ICU: for further management and neuroprognostication

Don't forget the ABCs of postresuscitation care: Obtain an ABG, BP, and Chest x-ray, Draw blood for laboratory studies, and ensure an ECG is performed. Talk to the Family, Give thanks to the team, consider initiation of Hypothermia, and admit to ICU.

• Neuroprognostication after cardiac arrest is complex and should be conducted by specialists.

• The extent of irreversible loss of brain function can be estimated clinically (e.g., neurological examination, apnea testing) and using ancillary brain death tests (e.g., EEG).

• Brain death assessment is typically carried out 72 hours after cardiac arrest or cessation of TTM.

• Consider organ donation for all patients with ROSC in whom brain death is declared.

• If ROSC does not occur, kidney and liver donation may still be possible, depending on the center.

• See “Organ and tissue donation” for related clinical, systemic, legal, and ethical issues.