Last updated: July 28, 2021
Version control: Our ACLS, PALS & BLS courses follow 2020 American Heart Association® Guidelines for CPR and ECC. American Heart Association® guidelines are updated every five years. If you are reading this page after December 2025, please contact firstname.lastname@example.org for an update. Version 2021.01.c
When there is the return of spontaneous circulation, maintain the SpO2 >92%. Consider endotracheal intubation and confirm and monitor placement with waveform capnography. Be sure to avoid hyperventilating the patient as this can increase intrathoracic pressure and decrease cardiac output.
Maintain breaths at 10 breaths per minute and titrate to a target PETCO2 of 35–45 mm Hg. Monitor and treat hypotension by establishing IV/IO access and administer a bolus of fluid, use vasopressors, obtain a 12-lead ECG, and consider probable causes of cardiac arrest. Vasopressor support can be an epinephrine infusion, dopamine infusion, and/or norepinephrine infusion. The patient will require a cardiac catheterization if there is ST-segment elevation myocardial infarction, unstable cardiogenic shock, or if they require circulatory support. If the patient is following commands they will continue advanced critical care. If the patient is not following commands, start targeted temperature management, obtain a brain CT, continue cardiac monitoring and admit for advanced critical care.
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