Examqo › Examqo library › Emergency medicine › Resuscitation and the undifferentiated patient · IMLE
Post-cardiac arrest care
After return of spontaneous circulation (ROSC) the aim is to prevent a second hit to the brain and heart — normal oxygenation and ventilation, a mean arterial pressure of 65 or more, fever prevention, treatment of the cause (above all PCI for STEMI) and no premature decisions on prognosis.
Why it matters in the exam
Questions on the phase after resuscitation test the order of actions in the first minutes after ROSC: securing the airway, oxygen and carbon-dioxide targets, blood-pressure targets, a 12-lead ECG and the decision on angiography. A common distractor is prolonged 100% oxygen — hyperoxia is harmful, and the target is a saturation of 94–98%.
Another recurring theme is temperature control in the patient who does not wake — keeping fever away actively for a minimum of 72 hours — and the question of prognosis: a poor neurological prognosis is not declared before at least 72 hours after ROSC, and the decision rests on several tests together rather than one sign.
In practice most questions present a patient whose pulse has just returned after ventricular fibrillation or asystole and ask for the next step from a list in which several answers sound reasonable. Remember that the aim at this stage is to keep the brain and heart perfused and prevent further injury; any action that does not serve this — non-urgent imaging, lowering the blood pressure or an early decision to withdraw care — is not the right step.
Key points
- Oxygenation targets: SpO2 94–98%; PaCO2 35–45 mmHg.
- MAP 65 mmHg or more; noradrenaline is the usual vasopressor.
- ECG immediately after ROSC; STEMI — urgent angiography.
- In the patient who does not wake — active temperature control, keeping fever away for a minimum of 72 hours.
- Prognosis — not before 72 hours, and only by combining several tools.
Summary table
| System | Target | How |
|---|---|---|
| Breathing | SpO2 94–98%, PaCO2 35–45 mmHg | Intubate the unconscious patient, titrate FiO2, ventilate to normocapnia |
| Circulation | MAP 65 mmHg or more, systolic above 90 | Fluids, noradrenaline, dobutamine for poor cardiac function |
| Heart | Detect acute coronary occlusion | ECG at once; urgent angiography for STEMI; without STEMI — an individual decision |
| Brain | Prevent fever and secondary injury | Active temperature control (prevent fever above 37.7 °C) for at least 72 hours; EEG if seizures are suspected |
| Metabolic | Normal glucose and electrolytes | Avoid hypoglycaemia, correct potassium |
| Prognosis | Not before 72 hours | Clinical examination, SSEP, NSE, imaging and EEG — together |
A free exam question
איזו מהפעולות הבאות יש לבצע בחשד ל-INTRACRANIAL PRESSURE מוגבר לאחר החייאה, אצל מטופל עם המדדים הבאים? סטורציה 93%, דופק 110, לחץ דם 86/58 mmHg. (the question as examined, in Hebrew)
- א. מתן LEVETIRACETAM
- ב. מניעת כיפוף הצוואר לצדדים
- ג. מנות חוזרות של MORPHINE
- ד. ניקוז CSF באמצעות דיקור מותני
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Emergency medicine, Medical licensing exam (IMLE), Internal medicine, Anesthesiology.
Subscriber? Read the full topic Plans and prices 25 free questions
Sources
- European Resuscitation Council and European Society of Intensive Care Medicine Guidelines, 2021 (with the 2025 update) — Post-resuscitation care
- American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, 2025 — Post-cardiac arrest care
- Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th edition (2020) — Post-cardiac arrest syndrome
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.