Arrhythmia, cardiac arrest and post-arrest care

Also known as Cardiac arrest · Advanced Life Support (ALS) · Post-cardiac arrest syndrome · Targeted temperature management (TTM) · Ventricular fibrillation (VF) · Refractory VF · Extracorporeal CPR (ECPR)

Cardiac arrest in the ICU requires immediate Advanced Life Support per ERC 2021 guidelines: high-quality CPR (rate 100-120, depth 5-6cm, full recoil), early defibrillation for shockable rhythms (VF/pVT), adrenaline 1 mg IV every 3-5 minutes, amiodarone 300 mg for refractory VF. Post-arrest care per ERC/ESICM 2021: targeted temperature management (TTM2: normothermia with fever prevention is as good as 33C hypothermia, which caused more haemodynamically compromising arrhythmia), urgent coronary angiography for a cardiac cause, lung-protective ventilation, haemodynamic optimisation, neuroprognostication deferred to at least 72 hours. ECPR for refractory cardiac arrest in selected, high-volume centres.

high33 referencesUpdated 19 Aug 202614 min readSource-verified · Sept 2026

Checked against its sources on 11 Sept 2026

Practise this topic

8 MCQs

^[1] ^[2] ^[3] ^[8]

Meet the patient

A 58-year-old man is wheeled into your ICU comatose after an out-of-hospital VF arrest — bystander CPR, three shocks, adrenaline 1 mg, amiodarone 300 mg, ROSC at 18 minutes. He is intubated, GCS 4, BP 88/50, temperature 37.2C, and the ECG shows anterior STEMI across V1 to V4.^[1]

Three decisions. The temperature target after ROSC, the timing of coronary angiography, and the timing of neuroprognostication — each worked through below in trial order.^[2]^[15]

References33Show

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