Post-Cardiac Arrest Care and Team Dynamics
Immediately after ROSC
Support oxygenation and ventilation: titrate oxygen to an SpO₂ of 92–98% and avoid hyperoxia, and target a PaCO₂ of 35–45 mmHg - do not hyperventilate. Support blood pressure with fluids and vasopressors to a mean arterial pressure of about 65 mmHg or higher, guided by bedside monitoring and lactate. Obtain a 12-lead ECG; ST-elevation myocardial infarction goes to emergent coronary angiography. Check glucose and electrolytes, treat seizures, and obtain an EEG in the comatose patient.
Temperature and prognostication
Comatose survivors receive targeted temperature management at 32–36 °C for at least 24 hours, then slow rewarming (about 0.25–0.5 °C/hour) with active avoidance of fever afterward. Do not prognosticate early; neurologic assessment is unreliable before roughly 72 hours after rewarming, and decisions should be multimodal, not based on a single finding.
Team dynamics
A resuscitation succeeds on structure. The team leader assigns roles early - compressor, airway, monitor/defibrillator, IV/IO, recorder, and timekeeper - and stands back to monitor quality rather than doing tasks personally. Use closed-loop communication: name the person, give the order, hear it read back, and confirm completion. Practice constructive intervention, knowledge sharing, and mutual respect, and close every event with a debriefing.
Traps
Continuing 100% oxygen indefinitely. Hyperventilation. Declaring a poor prognosis at 24 hours. Questions that describe a leader performing every task themselves - the correct answer is delegation and quality monitoring.
Rule of thumb
Give the order to a name, hear it back, and confirm it done.