1. The major factors contributing to mortality after successful resuscitation are progression of the primary disease and cerebral damage experienced as a result of the cardiac arrest. Furthermore, even brief cardiac arrest causes generalized decreases in myocardial function (global myocardial stunning) and may require treatment with inotropic drugs.
   1. When cerebral blood flow is restored after a period of global cerebral ischemia, there are initially multifocal areas of the brain with no reflow (this may reflect the effects of epinephrine administered during CPR) followed within 1 hour by global hyperemia, which is followed quickly by global hypoperfusion.
   2. Support after resuscitation is focused on providing stable oxygenation (PaO₂ >100 mm Hg), ventilation (PaCO₂ 25–35 mm Hg), neuromuscular blockers to prevent coughing or restlessness, and optimal hemodynamics (hematocrit, 30%–35%).
      1. A brief (5 min) period of hypertension (mean arterial pressure, 120–140 mm Hg) may help overcome the initial cerebral no reflow.
      2. Hyperglycemia during cerebral ischemia results in increased neurologic damage. Although it is unknown if hyperglycemia in the postresuscitation period influences outcome, it seems prudent to maintain the blood glucose level between 100 and 250 mg/dL.
      3. Increased intracranial pressure (ICP) is unusual after resuscitation from cardiac arrest. (Ischemic injury may lead to cerebral edema and increased ICP in the ensuing days.)
      4. In contrast to general supportive care, specific pharmacologic therapy directed at brain preservation has not been shown to have further benefit.
   3. Most severely damaged victims die of multisystem organ failure within 1 to 2 weeks.
   4. It is recommended that unconscious patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32°C to 34°C for 12 to 24 hours when the initial rhythm was ventricular fibrillation. Such cooling may also be beneficial for other rhythms or in-hospital cardiac arrest.
2. Prognosis. Most patients who completely recover show rapid improvement in the first 48 hours.

Cardiopulmonary Resuscitation

1. History
2. Scope of the Problem
3. Ethical Issues: Do Not Resuscitate Orders in the Operating Room
4. Components of Resuscitation
5. Pharmacologic Therapy
6. Electrical Therapy
7. Putting It All Together
8. Pediatric Cardiopulmonary Resuscitation
9. Postresuscitation Care