Cardiac Arrest & Post-ROSC CareICU / resuscitation

Collapse, pulseless — start the clockwork: quality CPR, adrenaline every 3–5 min, shock the shockable, hunt Hs & Ts, then protect the brain after ROSC.

• Witnessed vs unwitnessed + downtime
• ETCO₂ <10 despite quality CPR
• Post-ROSC papilloedema/fixed pupils (do not act early)
• Recurrent VF — overdrive pacing/ischaemia

• Acute MI (commonest)
• PE — thrombolyse intra-arrest if suspected
• Hyperkalaemia (dialysis patient, peaked T)
• Toxins: β-blocker, CCB, tricyclic, local anaesthetic (lipid)

• Adrenaline: 1 mg q3–5 min; early in non-shockable
• Amiodarone: 300 mg after 3rd shock (150 mg after 5th)
• Cath lab: STEMI (or shock/refractory ventricular arrhythmia/ongoing ischaemia) post-ROSC regardless of coma; not routine for comatose non-STEMI

• ETCO₂ is your CPR quality gauge — <10 mmHg means push harder/rotate
• Adrenaline + amiodarone (or lidocaine alternative) are the antiarrhythmic/evidence drugs in arrest; vasopressin has no role
• Post-ROSC hypotension (SBP <90) doubles mortality — noradrenaline early

• Hyperoxia after ROSC — titrate O₂ down to SpO₂ 90–98%
• Vasopressin — no role in cardiac arrest (2025 AHA)
• Routine immediate cath for comatose non-STEMI (COACT/TOMAHAWK) — emergent cath only for STEMI/shock/refractory ventricular arrhythmia/ongoing ischaemia
• Give routine sodium bicarbonate or calcium
• Stop to check pulses mid-cycle for >10 s
• Prognosticate in the first 72 h — sedation and TTM confound everything

• Freon-style interruptions for intubation
• Delaying access — IV is first choice (COR 1); IO reasonable if IV unsuccessful/not feasible (COR 2a, 2025 AHA)
• Hypoglycaemia missed as cause
• Early withdrawal discussions before 72 h

All ROSC → ICU; coronary angiography if STEMI or unstable; daily sedation holds from 48–72 h for neuro assessment; family communication early and honest.