Table 2.

Summary of key elements of general supportive care for post-resuscitation care

	Current evidence and key message	Recommendation
Oxygenation	▶ Hyperoxia is associated with brain injury in animal studies due to free radical formation ▶ Conflicting results from studies of hyperoxia and post-cardiac arrest survival in humans ▶ No clear benefit of maintaining supra-normal oxygen levels post arrest	Titrate oxygenation to maintain pulse oximetry around 95%
Ventilation	▶ Hypocapnia may decrease cerebral blood flow and lead to worse neurological outcome ▶ Hypercapnia may be neuroprotective although the evidence is mixed	Routine hyperventilation should be avoided. Maintain normal PaCo₂ (35–45 mm Hg)
Blood pressure	▶ Hypotension is common post arrest and is associated with worse outcomes ▶ Cerebral autoregulation may be impaired post arrest, making cerebral perfusion sensitive to hypotension ▶ Circulatory support post arrest may include intravenous fluids, vasopressors, inotropes and consideration for mechanical circulatory support ▶ Early haemodynamic optimisation similar to the approach used for sepsis has been advocated for post-cardiac arrest syndrome based on their shared pathophysiology. Although no randomised trials exist, outcomes were improved in a study that implemented haemodynamic optimisation as part of a bundled intervention compared to historical controls	Haemodynamic management should be guided by clinical judgement and may include use of intravenous fluids, vasopressors and inotropes Mechanical circulatory support devices may be considered in patients with advanced myocardial dysfunction
Seizure control	▶ Seizures may occur in 10–15% of patients post arrest and are associated with worse outcomes ▶ Seizures may be difficult to diagnose in post-arrest patients in absence of EEG monitoring especially in patients treated with hypothermia ▶ Randomised trials of seizure prophylaxis in improving survival have been negative	Periodic or continuous EEG monitoring is recommended to diagnose and treat subclinical seizure Antiseizure prophylaxis is not recommended Aggressive treatment of first seizures is recommended
Glucose	▶ Hyperglycaemia is common post cardiac arrest and is associated with increased risk of neurological injury ▶ Randomised trials comparing strict glucose control with moderate control post arrest showed no benefit of strict control in cardiac arrest as well as otherwise critically ill patients	Avoid hypoglycaemia Glucose levels >10 mmol/L (180 mg/dL) may need treatment with insulin
Steroids	▶ Adrenal insufficiency may develop post-cardiac arrest ▶ Steroids may provide haemodynamic stability and reduce inflammation ▶ One randomised trial from three centres in Greece showed that a combination of vasopressin, epinephrine intra-arrest and steroids post arrest led to improved rates of survival. Other studies of steroids post arrest have been negative	Routine use of steroids post arrest is not recommended