Anoxic Brain Injury

The Second Resuscitation After ROSC: Preventing Secondary Hypoxic–Ischemic Brain Injury Before Prognostication

Post–cardiac arrest brain injury evolves through ischemia, reperfusion, and secondary systemic insults. Early care prioritizes controlled oxygenation and ventilation, individualized perfusion, active fever prevention, seizure surveillance, and minimized sedation while avoiding premature neurological conclusions.

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The First ICU Day After ROSC: Controlling Oxygen, Carbon Dioxide, Perfusion, and Temperature

Post-arrest care is a second resuscitation: correct hypoxemia and hypocapnia, individualize perfusion, actively control temperature and fever, prevent metabolic extremes, and use EEG when command-following does not return. Trials support disciplined physiologic control but not routine high MAP targets, deliberate hypercapnia, or universal 33°C cooling.

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Neuroprognostication After Cardiac Arrest: Timing, Confounders, and Multimodal Concordance

Neuroprognostication after cardiac arrest requires adequate time, clearance of confounders, serial examination, and concordant evidence across genuinely independent modalities. Persistent coma or one abnormal test is not a verdict; when findings conflict, the defensible conclusion is indeterminate and continued reassessment may preserve the possibility of recovery.

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Joshua Lukas, MD (Instagram: @Neurointensivist)

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