These guidelines are for physicians who care for patients with return of spontaneous circulation (ROSC) after cardiac arrest, including emergency physicians, critical care physicians, and cardiologists
These guidelines update the 2010 International Liaison Committee on Resuscitation guidelines for patients with ROSC after cardiac arrest.
- Insert an advanced airway for comatose patients.
- Aim for SpO2 of at least 94% and use capnography to avoid hyperventilation.
- Systolic blood pressure goal is >100 mm Hg. Use isotonic fluids, an arterial line, and pressors/inotropes (recommend norepinephrine and dobutamine) as needed.
- Targeted temperature management is between 34-36°C. Use external cooling blanket, cold IV fluids, ice in axilla and groin or internal cooling catheter
- Coronary angiography is strongly recommended for patients with ST elevation or new left bundle branch block and potentially other patients.
- Keep potassium between 4.0 and 4.5 mmol/L and glucose below 180. Tight glucose control is not recommended.
- Emergency and hospital physicians should avoid the temptation to give a poor prognosis in the early hours after ROSC. Neuroprognostication should wait at least 48-72 hours after cardiac arrest.