Postresuscitation

Postresuscitation refers to the clinical phase after the return of spontaneous circulation following cardiac arrest. This period is marked by instability and by a syndrome that affects the brain, heart, and other organs. The goal is to stabilize perfusion, prevent secondary injury, and treat reversible causes.

The postresuscitation syndrome, or post-cardiac arrest syndrome, includes brain injury from ischemia and reperfusion, myocardial dysfunction, and a systemic inflammatory response with potential organ failure. Outcomes depend on neurologic injury, arrest duration, and comorbidities. Care is multidisciplinary and typically provided in an intensive care setting.

Management focuses on optimizing oxygen delivery and cerebral perfusion, controlling temperature, and preventing secondary injury. Airway and ventilation should maintain adequate oxygenation and normocapnia while avoiding lung injury. Blood pressure is supported to sustain mean arterial pressure targets; vasopressors may be needed. Temperature management, often involving targeted temperature management to 32–36°C for about 24 hours, is used to reduce neurologic damage and is followed by careful rewarming. Glucose control and infection prevention are important.

Cardiovascular evaluation seeks to identify and treat reversible causes. Coronary angiography and revascularization are considered when indicated. Neurologic assessment and continuous monitoring help detect seizures and guide therapy. Prognostication should be multimodal and delayed until stabilization and rewarming are complete, usually at least 72 hours after ROSC.

In summary, postresuscitation care influences survival and functional outcome and is guided by established resuscitation guidelines.