Immediate post-cardiac arrest care algorithm

After return of spontaneous circulation (ROSC), post–cardiac arrest care focuses on stabilizing airway, breathing, and circulation while identifying and treating reversible causes. Ventilation should be optimized by avoiding hyperventilation or hypoventilation, starting at about 10 breaths per minute and titrating to maintain a target PaCO₂ of 35–40 mm Hg, with waveform capnography if available. Oxygenation should be adjusted to the lowest FiO₂ necessary to maintain an SpO₂ between 90% and 98%. An advanced airway may be considered if needed. Hypotension should be treated to maintain a mean arterial pressure (MAP) ≥65 mm Hg, initially with IV/IO fluid boluses (1–2 L normal saline or lactated Ringer's), followed by vasopressor infusions such as epinephrine (2–10 mcg/min), dopamine (5–20 mcg/kg/min), or norepinephrine (0.1–0.5 mcg/kg/min) if required. Clinicians should evaluate and manage reversible causes, including hypovolemia, hypoxia, acidosis, electrolyte abnormalities (hypo-/hyperkalemia), hypothermia, tension pneumothorax, cardiac tamponade, toxins, and pulmonary or coronary thrombosis.

Ongoing management includes continuous cardiac monitoring, a 12-lead ECG to assess for STEMI, and urgent coronary angiography with transfer to the cardiac catheterization laboratory if indicated (e.g., STEMI or unstable cardiogenic shock requiring circulatory support). Additional evaluation may include EEG and CT brain imaging. Advanced critical care should incorporate targeted temperature management with a goal temperature of 32–37.5 °C, maintaining temperature control for at least 36 hours. If inducing hypothermia, cold (4 °C) IV fluids may be used when appropriate.