UMEM Educational Pearls

Postcardiac Arrest Syndrome: Controlled Reoxygenation

  • In previous pearls, Dr. Marcolini has highlighted the poscardiac arrest syndrome (PCAS), comprised of brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating disease.
  • Not surprisingly, postcardiac arrest brain injury is a major cause of morbidity and mortality, accounting for > 60% of deaths in some studies.
  • In addition to therapeutic hypothermia, consider "controlled reoxygenation" in order to optimize neurologic outcome.
  • Animal data has demonstrated that too much oxygen may worsen neuronal damage during the initial resuscitation phase.
  • Take Home Points:
    • Use a minimum amount of FiO2 to maintain SpO2 of 94-96%
    • Avoid unnecessary arterial hyperoxia


Nolan JP, Soar J. Postresuscitation care: entering a new era. Curr Opin Crit Care 2010;16:216-22.