Post-Resuscitation Care

• Stabilize circulation & prevent re-arrest
• Identify and treat reversible causes
• Temperature control
  • Aggressive cooling to 33 °C is no longer routinely recommended
  • Maintain core temperature ≤ 37.5 °C
  • Use antipyretics and surface cooling if needed
  • Monitor temperature closely during the first 72 hours
• History: obtain from staff, witnesses, or medical notes
• Key reversible causes to consider
  • Myocardial infarction
  • Hypoxia, hypoglycemia
  • Stroke, overdose, electrolyte imbalance
  • Trauma, pulmonary embolism, sepsis
• Documentation
  • Duration of arrest
  • Timeline of interventions and drug doses

Circulation

• Establish rapid IV / IO access
• Give 1–2 L isotonic crystalloids if preload responsive
  • Avoid excess fluids in CHF / pulmonary edema
• Initiate vasopressors early if hypotensive
  • Norepinephrine is first-line

Airway & breathing

• If intubating, use reduced sedation doses
• Avoid hyperventilation
  • Target SpO₂ > 94 %, PaCO₂ 40–50 mmHg

• Confirm bilateral ventilation
• Check for rib fractures
• Assess for new murmurs, JVP
• Rule out aneurysm, peritonitis
• Perform baseline neuro exam
• Assess brainstem reflexes: pupils, corneal, gag & cough
• Asymmetry may suggest a stroke or structural lesion
• Avoid early prognostication — findings may improve

Tubes & lines

• Convert emergency lines to a central line (sterile)
• Insert urinary catheter
• Consider NG tube if unconscious

• ECG: STEMI, arrhythmias, QTc, signs of PE
• ABG: mixed acidosis is common
  • May improve with oxygen and perfusion
  • Consider bicarbonate if severe
• CXR: confirm ETT placement +/− NGT & rule out pneumothorax
• Labs
  • CBC, coagulation, troponin, electrolytes & lactate
  • Repeat Q6H early on
• Toxicology screen if relevant
• Bedside Echo to assess regional wall-motion abnormalities
• CT head to rule out central causes

• Continuous cardiac monitoring
• Head of bed at 30°
• Maintain glucose 7.8–10 mmol/L
• Use EEG monitoring if needed
• Treat seizures & myoclonus with sedation and anticonvulsants
• Consider empiric antibiotics if aspiration is suspected

• Provide clear & realistic updates
• Explain clinical status and potential outcomes