Principles of Management of Postcardiac Arrest Patients in the ICU.

Abstract

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 (PaO2 75-100 mm Hg), and normocapnia (PaCO2 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.