Post-resuscitation care after cardiac arrest: ICU treatment and recovery

When someone has a cardiac arrest, CPR and defibrillation aim to restart the heart. Once it has restarted and is beating on its own, this is called return of spontaneous circulation, or ROSC. Resuscitation Council UK's 2025 guidelines, based on the European Resuscitation Council and European Society of Intensive Care Medicine guidance, say post-resuscitation care is started immediately after sustained ROSC, regardless of location.

The British Heart Foundation explains what this means for the person and family. After cardiac arrest you will be looked after in a coronary care or intensive care unit, where people who need special monitoring go so a close eye can be kept on them, and you may be kept asleep in an induced coma to allow your body to recover.

The guidelines describe an airway, breathing and circulation approach after ROSC. They advise inserting an advanced airway where skills are available, adjusting inspired oxygen to achieve an arterial oxygen saturation of 94 to 98%, ventilating the lungs to achieve normal carbon dioxide levels, and aiming for a systolic blood pressure above 100 mmHg or a mean arterial pressure above 60 to 65 mmHg.

For families, this can mean the person is on a ventilator with close monitoring. It can look alarming, but the targets above are the team's way of keeping oxygen and blood pressure at levels intended to protect the brain and other organs.

The guidelines say early identification of a non-coronary cause can be achieved by a transthoracic echocardiogram and a dual-phase whole-body CT scan at hospital admission. They prioritise immediate coronary angiography for patients with clear ST-elevation on the ECG or other high suspicion of coronary occlusion, for example haemodynamic or electrical instability, and advise a head-to-pelvis CT scan including CT pulmonary angiography if angiography does not identify causative lesions.

The BHF says doctors will want to work out what caused the cardiac arrest, so they can recommend medicine and treatment to reduce the risk of it happening again. These may include an implantable cardioverter defibrillator (ICD) or ablation, and referral to cardiac rehabilitation to help rebuild confidence, fitness and strength.

Resuscitation Council UK advises actively preventing fever by targeting a temperature of 37.5 degrees C or below for patients who remain comatose after ROSC. It also says to use short-acting sedative agents and daily sedation holds in ventilated patients, which may enable earlier clinical examination that is less confounded by sedation, and that there is insufficient evidence to recommend any specific neuroprotective drug for comatose survivors. Seizures are managed, using EEG to diagnose electrographic seizures where clinical convulsions occur.

The BHF explains why this matters: a lack of oxygen to the brain during a cardiac arrest can sometimes have long-term effects, which can include personality changes, problems with memory, tiredness, dizziness or balance issues, problems with speech and language, involuntary muscle movements and permanent brain injury.

For people who are still comatose, the guidelines say neurological prognostication should use clinical examination, electrophysiology, biomarkers and imaging, to inform relatives and to help clinicians target treatments based on the person's chance of a neurologically meaningful recovery. They stress using multimodal strategies, that the clinical neurological examination is central, that predicting poor outcome needs high specificity to avoid falsely pessimistic predictions, and that neurological prognosis is one of several aspects to consider in discussions about an individual's potential for recovery.

In practice, this means that a view on recovery draws on several kinds of information rather than one test, and families can reasonably ask the team what has been tested and what remains uncertain.

The BHF says the time it takes to recover depends on what caused the cardiac arrest and how long it took for the heart to beat on its own again. It could take several weeks, a few months or longer if more rehabilitation is needed for things like learning to walk and caring for yourself again. It advises talking to family and doctors about what will happen once you go home and about practical matters such as driving and returning to work.

Resuscitation Council UK advises functional assessments of physical and non-physical impairments before discharge to identify rehabilitation needs and early referral where indicated. The BHF lists problems with memory, personality changes, tiredness, dizziness or balance issues and problems with speech and language among the possible long-term effects, which is why assessment covers more than physical strength.

Post-resuscitation care is delivered by the NHS emergency, cardiology and intensive care teams as part of the emergency pathway. Cardiac rehabilitation and follow-up for an ICD or other treatments continue under the NHS.

Some survivors later seek private neuropsychology, physiotherapy or cardiology opinions for specific problems. These work best with the hospital discharge summary and test results to hand, and your GP can help coordinate who is responsible for what.