postROSC

Post-ROSC refers to the care delivered after return of spontaneous circulation following cardiac arrest. The main goals are to stabilize cardiopulmonary function, optimize organ perfusion, prevent secondary brain injury, and identify reversible causes. This phase is influenced by the post-cardiac arrest syndrome, a systemic inflammatory response affecting the brain, heart, lungs, and kidneys.

Airway management and ventilation aim to maintain adequate oxygenation and norms. Avoid prolonged hyperoxia; typical targets include oxygen saturation around 94-98% and PaCO2 in the normal range. Use lung-protective ventilation when feasible and adjust settings to minimize lung injury.

Hemodynamics are prioritized: maintain mean arterial pressure to ensure cerebral perfusion, commonly with MAP ≥65-70 mmHg, using fluids and vasopressors (norepinephrine as first line) as needed. Temperature management with targeted temperature management to 32-36°C for about 24 hours, followed by gradual rewarming, reduces neurologic injury in many comatose patients.

Neuroprognostication should be delayed for at least 24-72 hours in comatose patients due to confounders from sedation and edema. Multimodal assessment—clinical examination, electroencephalography, imaging, and biomarkers—guides prognosis and decisions about treatment intensity and withdrawal of life-sustaining therapy when appropriate.

Cardiac evaluation for acute coronary syndrome is essential; coronary angiography and revascularization are considered when indicated. Continuous organ support, infection prevention, glucose control, and involvement of multidisciplinary teams (ICU, cardiology, neurology, palliative care) are standard components of post-ROSC care.