A patient is brought to the ED following a cardiac arrest.  ROSC is achieved 1 minute after arrival to the ED.  What treatments should the ED physician provide to allow the best outcomes?

Caring for the post cardiac arrest patient is complex.  Efforts to avoid re-arrest and best practices regarding ventilation, oxygenation, and neurocritical care should be provided.  What are some of these?

1. Prevent recurrent cardiac arrest: Identify the underlying cause of the first arrest and treat it, manage shock and prevent further organ failure, advocate for re-vascularization when necessary.  In centers which have mechanical circulatory support programs, be knowledgeable of the inclusion and exclusion criteria of that program and consult early.

2. Avoid hyperoxia: Initial PaO2 > 200 have been associated with increased mortality and worse neurological outcomes.

3. Aim for normocapnia: PaCO2 35-45

4. Practice good neurocritical care: Observational data has been shown to favor a MAP > 80mmHg (though this has not been borne out in prospective studies).  Initiate early targeted temperature management per your institution’s guidelines.  Treat seizures.  Avoid inappropriate early neuroprognostication - early biomarker and imaging data may not paint the whole picture.

Reference: Steinberg A, Elmer J. Postarrest Interventions that Save Lives. Emergency Medicine Clinics of North America. 2020;38(4). doi:10.1016/j.emc.2020.06.001