Adult Post–Cardiac Arrest Care Algorithm - AHA2020

Initial Stabilization Phase - Resuscitation is ongoing during the post-ROSC phase, and many of these activities can occur concurrently. However, if prioritization is necessary, follow these steps:

 • Airway management: Waveform capnography or capnometry to confirm and monitor endotracheal tube placement

 • Manage respiratory parameters: Titrate FiO2 for SpO2 start at 10 breaths/min; titrate to PaCO2 of 35-45 mm Hg

 • Manage hemodynamic parameters: Administer crystalloid and/or vasopressor or inotrope for goal systolic blood pressure >90 mm Hg or mean arterial pressure >65 mm Hg

Continued Management and Additional Emergent Activities - These evaluations should be done concurrently so that decisions on targeted temperature management (TTM) receive high priority as cardiac interventions.

 • Emergent cardiac intervention: Early evaluation of 12-lead electrocardiogram (ECG); consider hemodynamics for decision on cardiac intervention

 • TTM: If patient is not following commands, start TTM as soon as possible; begin at 32-36°C for 24 hours by using a cooling device with feedback loop

 • Other critical care management

    - Continuously monitor core temperature (esophageal, rectal, bladder)

    - Maintain normoxia, normocapnia, euglycemia

    - Provide continuous or intermittent electroencephalogram (EEG) monitoring

    - Provide lung-protective ventilation



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