Principles of Post-Cardiac Arrest Management and Therapeutic Hypothermia EC Cardiology Editor’s Column - 2019 Citation : Ozgur Karcioglu. “Principles of Post-Cardiac Arrest Management and Therapeutic Hypothermia”. EC Cardiology ECO.02 (2019): 01-05. COLUMN ARTICLE Ozgur Karcioglu* Professor, Department of Emergency Medicine, Emergency Physician, Istanbul Research and Training Hospital, Istanbul, Turkey Therapeutic approaches to be employed following achievement of the return of spontaneous circulation (ROSC) via measures included in advanced life support in patients with cardiac arrest (CA) have been updated sub- stantially. The main goals of post-cardiac arrest manage- ment consist of elucidation of the causes of CA, minimizing cardiovascular and neurological damage and prevention of ischemia-reperfusion injury. The utilization of “therapeutic hypothermia” (TH) is be- ing used more widely. This approach is employed to treat hy- perthermia and brain injury which have been closely linked to death in ROSC-achieved patients following CA, while mitigating demand for glucose and oxygen. Recent studies cited that results of early institution of TH with a target of 36ºC is comparable to 32 - 34ºC regarding improvement of neurological outcomes. The technique can be divided into three phases; induction, maintenance and rewarming. The usefulness of TH is controversial in the elderly, those with poor outcome and is contraindicated in those with hemody- namic instability. Post-cardiac arrest management (PCAM), includes all measures following achievement of the return of sponta- neous circulation (ROSC) in patients with cardiac arrest (CA). These patients are not a homogeneous group; instead, they form a wide array of scenarios from a ROSC lasting for minutes followed by CA and death, to those discharged from hospital without any sequelae. Mainstays in the evaluation following ROSC Should ECG reveal ST elevation acute myocardial infarc- tion (STEMI) the patient has to be transferred to emergency coronary angiography. It should be kept in mind that many of those patients without an obvious STEMI in the ECG would still have significant coronary lesions. Patients with ventricular dysrhythmias as the first detectable rhythms in Abstract Keywords: Cardiac Arrest; Return of Spontaneous Circula- tion; Post-Cardiac Arrest Management; Therapeutic Hypo- thermia Principles of post-cardiac arrest management and therapeu- tic hypothermia Main goals in the management consist of searching for the cause(s) of CA, minimizing cardiovascular and neuro- logical damage and prevention of ischemia-reperfusion in- jury. The most important threat to life is re-emergence of CA in the very first minutes following achievement of ROSC. Nor- malization of blood pressure, fluid replacement, and resto- ration of end-organ perfusion are the essential approaches to prevent secondary injury attributed to hypotension. Ozgur Karcioglu Istanbul Research and Training Hospital, Istanbul, Turkey