Adult Immediate Post Cardiac Arrest Care

Step 1:
Return of Spontaneous Circulation (ROSC)

Step 2:
Optimize ventilation and oxygenation
     • Maintain oxygen saturation≥94%
     • Consider advanced airway and waveform capnography
     • Do not hyperventilate

Step 3:
Treat hypotension (SBP <90 mm Hg)
     • IV/IO bolus
     • Vasopressor infusion
     • Consider treatable causes
     • 12-Lead ECG

Step 4:
Follow commands?

Step 5:
Consider induced hypothermia

Step 6:
STEMI OR high suspicion of AMI

Step 7:
Coronary reperfusion

Step 8:
Advanced critical care
Yes    No
Yes    No

Doses/Details

Ventilation/Oxygenation
Avoid excessive ventilation. Start at 10-12 breaths/min and titrate to target PETCO2 of 35-40 mm Hg. When feasible, titrate FlO2 to minimum necessary to achieve SpO2 ≥94%.
IV Bolus
1-2 L normal saline or lactated Ringer’s. If inducing hypothermia, may use 4⁰C fluid.
Epinephrine IV Infusion:
0.1-0.5 mcg/kg per minute (in 70-kg adult: 7-35 mcg per minute)
Dopamine IV Infusion:
5-10 mcg/kg per minute
Norepinephrine IV Infusion:
0.1-0.5 mcg/kg per minute (in 70-kg adult: 7-35 mcg per minute)

Reversible Causes
     • Hypovolemia
     • Hypoxia
     • Hydrogen ion (acidosis)
     • Hypo-/hyperkalemia
     • Hypothermia
     • Tension pneumothorax
     • Tamponade, cardiac
     • Toxins
     • Thrombosis, pulmonary
     • Thrombosis, coronary

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