[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anaesthesia and ICU](https://durgical.com/en/anaesthesia/) › [Critical care (ICU)](https://durgical.com/en/anaesthesia/areas/critical-care/) › Care after cardiac arrest

# Care after cardiac arrest

- Concept

After the heart restarts, the ICU protects the brain and heart, finds the cause of the arrest and waits before predicting recovery.

Updated Nov 13, 2026

## Key points

- Aim for normal oxygen saturation (about 94–98%) and normal carbon dioxide; avoid both hypoxaemia and hyperoxia.
- Avoid hypotension: a usual target is a mean arterial pressure of at least 65 mmHg.
- Urgent coronary angiography for ST elevation after arrest, and considered when a coronary cause is likely.
- Actively prevent fever in comatose survivors; some centres keep a constant temperature between 32 and 36 °C.
- Do not prognosticate before about 72 hours after return of circulation; use several tests and exclude sedation.

## What it is

Return of spontaneous circulation is the start of a second phase, the post-cardiac arrest syndrome, which combines brain injury, myocardial stunning, a whole-body ischaemia-reperfusion response like sepsis, and the disease that caused the arrest. Care follows a bundle. The airway is secured and ventilation aims for normal oxygen saturation, avoiding both hypoxaemia and hyperoxia, and normal carbon dioxide. Blood pressure is supported to avoid hypotension, usually aiming for a mean arterial pressure of at least 65 mmHg, with fluids, vasopressors and inotropes as needed. A 12-lead ECG and urgent coronary angiography are done when ST elevation or a likely coronary cause is present. Temperature control is central: fever worsens brain injury, so it is actively prevented for at least the first days in patients who remain comatose; some centres maintain a constant lower temperature. Glucose is kept in a moderate range, seizures are looked for and treated, and sedation is kept light enough to allow assessment. Prognosis of brain recovery should not be decided early: it is assessed no sooner than about 72 hours after return of circulation and after sedation has cleared, using several tests together. Rehabilitation, investigation of the cause, and family support complete the care.

## Key points

- Post-cardiac arrest syndrome: brain injury, myocardial dysfunction, systemic ischaemia-reperfusion response, and the cause of the arrest.
- Hypoxaemia, hypotension, fever, high or low glucose and seizures all add secondary brain injury and are preventable.
- Myocardial stunning often improves over the first days; early echo guides inotrope use.
- Multimodal prognostication combines examination (pupillary and corneal reflexes, motor response, myoclonus), EEG, evoked potentials, a blood biomarker and brain imaging.
- Patients who do not recover may progress to brain death; organ donation and limits of treatment are discussed in line with law and the family's wishes.

## How it works

- Ischaemia and reperfusion trigger calcium overload, free radicals and inflammation that keep injuring neurons for hours to days.
- Fever raises brain metabolic demand and excitotoxicity; controlling temperature reduces this secondary injury.
- The heart is stunned by global ischaemia and by defibrillation and adrenaline, lowering output for a period.
- A systemic inflammatory response causes vasodilation and capillary leak, which can look like septic shock.

## In practice

- Keep sedation and neuromuscular blockade in mind when examining: they can mimic poor brain function.
- Look for and treat seizures, ideally with EEG monitoring, as they may be non-convulsive.
- Shivering during temperature control raises oxygen use; treat it with warming of the skin, sedation and other measures.
- Avoid early withdrawal of treatment based on one bad sign (a self-fulfilling prophecy).
- Before discharge, consider an implantable defibrillator, cardiac rehabilitation and screening for cognitive and emotional problems.

## Next step

- Admit to intensive care with continuous ECG, arterial line, capnography, temperature and glucose monitoring.
- Call cardiology for angiography if there is ST elevation or a likely coronary cause, and neurology when prognostication begins.
- Plan a multimodal neurological assessment no sooner than about 72 hours after return of circulation, once sedation has cleared.
- Meet the family early and often; discuss uncertainty, goals of care and, when relevant, limits of treatment or donation.
- Arrange rehabilitation and follow-up for physical, cognitive and emotional recovery after discharge.

## Test yourself

Think of the answer, then tap the question to see it.

## What are the four components of post-cardiac arrest syndrome?

Brain injury, myocardial dysfunction, a systemic ischaemia-reperfusion response, and the persisting cause of the arrest.

## Why is fever actively prevented after cardiac arrest?

Fever raises cerebral metabolic demand and worsens secondary brain injury; preventing it is linked to better neurological outcome.

## When should neurological prognosis be assessed after cardiac arrest?

No sooner than about 72 hours after return of circulation, after sedation has cleared, combining several tests rather than relying on one.

## Why should hyperoxia be avoided after return of spontaneous circulation?

Excess oxygen increases free radical production during reperfusion and may worsen brain injury; normal saturation is the aim.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anaesthesia/care-after-cardiac-arrest/)

## Elsewhere in DurgiPedia

- [Body temperature regulation](https://durgical.com/en/physiology/body-temperature-regulation/)
- [Cerebral blood flow, brain metabolism and intracranial pressure](https://durgical.com/en/physiology/cerebral-blood-flow-brain-metabolism-and-intracranial-pressure/)
- [STEMI and its territories, and STEMI mimics](https://durgical.com/en/clinical-skills/stemi-and-its-territories-and-stemi-mimics/)
- [Limiting life-sustaining treatment: withholding and withdrawing](https://durgical.com/en/medical-ethics/limiting-life-sustaining-treatment-withholding-and-withdrawing/)
- [Brain death: the ethical and legal criteria in Colombia](https://durgical.com/en/medical-ethics/brain-death-the-ethical-and-legal-criteria-in-colombia/)

## Connections

## Related 6

- [Advanced life support in hospital](https://durgical.com/en/anaesthesia/advanced-life-support-in-hospital/)
- [The comatose patient in the ICU](https://durgical.com/en/anaesthesia/the-comatose-patient-in-the-icu/)
- [Brain death: clinical testing (Colombia)](https://durgical.com/en/anaesthesia/brain-death-clinical-testing/)
- [Analgesia and sedation in the ICU: targets and scales](https://durgical.com/en/anaesthesia/analgesia-and-sedation-in-the-icu-targets-and-scales/)
- [Shock: a bedside approach by type](https://durgical.com/en/anaesthesia/shock-a-bedside-approach-by-type/)
- [Mechanical ventilation modes: volume, pressure and support](https://durgical.com/en/anaesthesia/mechanical-ventilation-modes-volume-pressure-and-support/)

## Related conditions 4

- [Cardiac arrest (VF, pulseless VT, asystole, PEA)](https://durgical.com/en/conditions/cardiac-arrest/)
- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)
- [Cardiogenic shock](https://durgical.com/en/conditions/cardiogenic-shock/)
- [Accidental hypothermia](https://durgical.com/en/conditions/accidental-hypothermia/)

## In Pharmacology 3

- [Vasopressors and inotropes](https://durgical.com/en/pharmacology/classes/vasopressors-and-inotropes/)
- [Norepinephrine](https://durgical.com/en/pharmacology/norepinephrine/)
- [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/)

[← All of anaesthesia](https://durgical.com/en/anaesthesia/)

Educational content; it does not replace supervised training, your institution's protocols or the anaesthetist's or intensivist's decision. It contains no doses and no ventilator or infusion settings.

Sources: [Targeted Temperature Management](https://www.ncbi.nlm.nih.gov/books/NBK556124/) (StatPearls (NCBI Bookshelf), 2023); [Advanced Cardiac Life Support (ACLS)](https://www.ncbi.nlm.nih.gov/books/NBK613285/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anaesthesia/care-after-cardiac-arrest/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anaesthesia/care-after-cardiac-arrest/