Cardiovascular Critical Care II

resuscitation was associated with a significantly decreased chance of survival to discharge

viii.

Cyclosporine - A randomized, single-blind trial found no impact on target organ damage,

2016;1:557-65).

For information on acute symptomatic arrhythmias (bradycardias and tachycardias), see the

Cardiovascular Critical Care I chapter.

arrest care can be divided into initial (stabilization phase) and subsequent (continued management and

additional emergent activities) (Circulation 2010;122:S768-786; Circulation 2008;118:2452-83; Circulation

2020;142:S366-S468).

Initial

Optimize hemodynamics: Target MAP 65–100 mm Hg, central venous pressure 8–12 mm Hg,

central venous oxygen saturation greater than 70%, urine output greater than 1 mL/kg/hour, and

normal serum lactate.

Consider the patient’s normal BP, cause of arrest, and severity of myocardial dysfunction for all

values above. Recent study has found that lower MAP goals (63 mm Hg vs. 77 mm Hg) did not

portend worse survival or neurologic outcomes (N Engl J Med 2022;387:1456-66).

ii.

Use intravenous crystalloids and colloids, continuous vasopressors and inotropes, transfusions,

and renal replacement as needed to meet target goals.

iii.

In a randomized study of vasopressor dependent shock post-cardiac arrest, the provision of

corticosteroids (hydrocortisone 100 mg intravenously every 8 hours x 7 days or until shock

reversal) did not improve time to shock reversal, rate of shock reversal, or clinical outcomes

Transfer patient to a system (OHCA) or unit (IHCA) that can provide advanced post–cardiac

arrest care, including continuous electrocardiographic (ECG) monitoring with immediate 12-lead

ECG, central intravenous access if possible, coronary reperfusion, and/or temperature control (i.e.,

targeted temperature management).

Try to identify and treat the reversible causes of cardiac arrest (Table 2). Laboratory and diagnostic

tests should be performed to aid in identifying a potential underlying cause.

Consider body temperature regulation. Should be considered for any patient with ROSC who does

not follow commands (i.e., comatose) after cardiac arrest.

The terminology “temperature control” that encompass the practices of hypothermia,

normothermia, and fever prevention, has replaced the previous “targeted temperature

management” terminology (Perman 2024).