Post-Cardiac Arrest Care Basics

Return of spontaneous circulation (ROSC) restores a pulse, but it does not restore normal physiology. The patient has moved from cardiac arrest into post-cardiac arrest syndrome, in which four processes interact: - Post-arrest brain injury from the original low-flow state and subsequent reperfusion - Post-arrest myocardial dysfunction, often called stunned myocardium - A systemic ischaemia-reperfusion response resembling sepsis, with inflammation, endothelial activation, vasodilation, and coagulopathy - The persistent pathology that caused the arrest, such as coronary occlusion, pulmonary embolism, hypoxia, haemorrhage, or toxin exposure Reperfusion is necessary, but it can also injure previously ischaemic cells. The sudden return of oxygenated blood promotes reactive oxygen species, excitotoxicity, ionic imbalance, inflammation, and apoptosis. This is why post-ROSC care aims for controlled, moderate physiology rather than “maximum” oxygen, ventilation, temperature reduction, or glucose lowering. A patient can therefore have a palpable pulse while still developing cerebral oedema, myocardial failure, recurrent ventricular arrhythmia, shock, seizures, or a second arrest. Treating the blood pressure alone misses the brain, the systemic response, and the original cause.