Rao A, Aafreen A, Agrawal A, Rao SJ, Sharma S, Sattur S, Kaluski E. Post-cardiac arrest care: An integrated approach to management after resuscitation. World J Cardiol 2026; 18(6): 121197 [DOI: 10.4330/wjc.121197]
Corresponding Author of This Article
Adishwar Rao, MD, Department of Internal Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA 18840, United States. adishwar.rao@guthrie.org
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
review-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Rao A, Aafreen A, Agrawal A, Rao SJ, Sharma S, Sattur S, Kaluski E. Post-cardiac arrest care: An integrated approach to management after resuscitation. World J Cardiol 2026; 18(6): 121197 [DOI: 10.4330/wjc.121197]
Adishwar Rao, Asna Aafreen, Akriti Agrawal, Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
Shiavax J Rao, Saurabh Sharma, Sudhakar Sattur, Edo Kaluski, Department of Cardiology, Guthrie Robert Packer Hospital, Sayre, PA 18840, United States
Saurabh Sharma, Sudhakar Sattur, Edo Kaluski, Department of Cardiology, Geisinger Commonwealth School of Medicine, Scranton, PA 18509, United States
Author contributions: Rao A designed the research study, performed the literature review, interpreted the data, and drafted the manuscript; Aafreen A, Agrawal A, and Rao SJ contributed to literature review, data interpretation, and manuscript revision; Sharma S, Sattur S, and Kaluski E provided critical intellectual input, supervised the study, and revised the manuscript for important scientific content; and all authors reviewed and approved the final manuscript.
AI contribution statement: Authors do not declare use of artificial intelligence in the preparation of the manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Adishwar Rao, MD, Department of Internal Medicine, Guthrie Robert Packer Hospital, One Guthrie Square, Sayre, PA 18840, United States. adishwar.rao@guthrie.org
Received: March 18, 2026 Revised: May 11, 2026 Accepted: May 26, 2026 Published online: June 26, 2026 Processing time: 92 Days and 16.7 Hours
Abstract
Post-cardiac arrest care is key in determining neurological recovery and survival after return of spontaneous circulation (ROSC). Despite recent advances, post-arrest mortality remains high due to myocardial dysfunction, cerebral injury, and systemic inflammation. Guidelines recommend avoiding hypotension and using individualized hemodynamic targets with a mean arterial pressure ≥ 65 mmHg commonly used as an initial threshold, although higher targets may be considered in select patients with impaired cerebral autoregulation. Early coronary angiography and revascularization are indicated for ST-elevation myocardial infarction but have not demonstrated a mortality benefit in non-ST-elevation cohorts. Current evidence increasingly emphasizes strict fever prevention and individualized temperature management strategies, while uncertainty remains regarding which patient subgroups may benefit from deeper hypothermia. Post-ROSC ventilation strategies suggest avoiding both hypoxemia and severe hyperoxemia, targeting peripheral oxygen saturation of 92%-98% and normocapnia. Sedation with propofol or dexmedetomidine and analgesia with fentanyl/remifentanil, with appropriate shivering control, enhances targeted temperature management tolerance. Multimodal neuroprognostication incorporating neurological examination, electrophysiology, neuroimaging, and biomarkers (such as neuron-specific enolase and neurofilament light chain) should be performed. Early prognostic findings should be interpreted cautiously to minimize premature withdrawal of life-sustaining therapy. Future research should refine hemodynamic, temperature, and prognostic targets to optimize individualized post-resuscitation care for patients with cardiac arrest.
Core Tip: Post-cardiac arrest syndrome remains associated with high mortality and poor neurological outcomes despite advances in resuscitation care. This review summarizes the current evidence on comprehensive post-resuscitation management, including hemodynamic optimization, coronary interventions, targeted temperature management, ventilation, metabolic support, sedation, and multimodal neuroprognostication. Current evidence increasingly favors strict fever prevention and individualized management strategies over uniform protocol-driven targets. Early multidisciplinary care and cautious delayed neuroprognostication remain critical to minimizing secondary neurologic injury and improving outcomes after cardiac arrest.
