Principles of Management of Postcardiac Arrest Patients in the ICU

Summary:

Postcardiac arrest (CA) care in the intensive care unit is pivotal to mitigating hypoxic–ischemic brain injury (HIBI), the leading cause of death and disability in resuscitated patients. This narrative review synthesizes current evidence and guideline recommendations on key domains of post-CA management, including diagnostic evaluation, hemodynamic optimization, oxygenation and ventilation strategies, temperature control, and sedation. Immediate coronary angiography is indicated in patients with ST-segment elevation, while a selective approach is warranted in others, guided by clinical findings. Whole-body computed tomography facilitates early identification of extracardiac causes and resuscitation-related injuries. Current consensus supports maintaining mean arterial pressure above 60 to 65 mm Hg, normoxemia (PaO ₂ 75–100 mm Hg), and normocapnia (PaCO ₂ 35–45 mm Hg). Lung-protective ventilation and head-up positioning are standard practices. Recent high-quality trials have challenged the neuroprotective role of therapeutic hypothermia; current guidelines recommend active fever prevention targeting a temperature of ≤37.5° C for at least 72 hours after CA. Sedation should be tailored to facilitate neurologic assessment, with short-acting intravenous agents preferred.