PCAS consist of five phases: the immediate phase (20 minutes after the return of spontaneous circulation ROSC), early phase (from 20 minutes to 6–12 hours after ROSC), intermediate phase (from 6–12 to 72 hours after ROSC), recovery phase (3 days after ROSC), and the rehabilitation phase. Management of PCAS is inherently variable, as it depends on the phase, organ systems affected and overall patient presentation. With the exception of targeted temperature management, there is no treatment that is unique to the pathophysiology of PCAS; therefore PCAS treatment is largely system-dependent, supportive treatment. Targeted Temperature Management Targeted Temperature Management (TTM) is the use of various cooling methods to reduce a patients internal temperature. The main methods of cooling include using either cold intravenous solutions or by circulating cool fluids through an external, surface blanket/pad. While most commonly applied as a post-ROSC intervention, there are some studies and EMS systems that start the cooling process in the initial inta-arrest stage. Patients are generally cooled to a range of 32-36°C. As of January 2021, there is active debate about the ideal cooling temperature but there is generally agreement that PCAS patients benefit by not being hyperthermic. TTM is an important therapy in PCAS because it directly targets the systemic nature of the pathophysiological inflammatory and metabolic processes. TTM works through three major mechanisms. First, it decreases metabolism 6% to 7% per 1°C decrease in temperature. Second, it decreases cell apoptosis which reduces tissue damage. Third, TTM directly reduces inflammation and ROS production. System-based Treatment PCAS can present variably depending on intra-arrest dynamics and patient-specific variables. Therefore, there is no universally applicable treatments for PCAS other than TTM. However, because there are generally predicable problems, the table below presents some of the more common treatments; supporting one organ system generally has mutual benefits for the healing of other body systems. These treatments, while common, may not be applicable to every patient. + System Common Complications Common Supportive Treatments Brain Hypoxic brain injury, seizures Hemodynamic monitoring and optimization, Ventilator management, glucose control, antiepileptics Cardiovascular Hemodynamic instability, cardiogenic shock, myocardial infarction, dysrhythmia Hemododynamic monitoring, vasopressors, antiarrhythmics, diuretics, blood transfusion, crystalloid therapy, ACLS, PCI, ECMO Pulmonary ARDS, pneumonia, pulmonary contusion, pulmonary edema Intubation, ventilator management, oxygen therapy, antibiotics Renal Acute Kidney Injury, electrolyte imbalances, metabolic acidosis Dialysis, electrolyte replacement, diuretics Hepatic Acute Liver Injury, hypoxic hepatitis Transplantation Coagulatory Thrombosis (Pulmonary embolism, DVTs), DIC Anti-Coagulation, fibrinolytics, platelet transfusion, IVCF Endocrine Dysglycemia, adrenal disorders Insulin therapy, glucose therapy, corticosteroids
Post-Cardiac Arrest Syndrome
Post-intensive care syndrome
Postpericardiotomy syndrome
Acute coronary syndrome
Acute aortic syndrome
Acute chest syndrome
Fat embolism syndrome
Edwards syndrome