Physiological targets for prehospital adult post-ROSC management

This narrative review aims to present the latest findings on physiological targets for postresuscitation management of cardiac arrest and to discuss the recent treatment recommendations from the International Liaison Committee on Resuscitation (ILCOR).

Evidence supports targeting normal physiological ranges. ILCOR recommends maximal oxygen until reliable O 2 saturation (O 2 Sat) is achieved, then titrate to 94-98%. Avoid hypoxia (O 2 Sat < 90%), even transient hypoxia is associated with worse outcomes. Pulse oximetry may be less accurate in patients with darker skin, potentially masking hypoxemia. For end-tidal carbon dioxide (ETCO 2 ), aim for the upper end of normal (ETCO 2 35-45 mmHg) to account for alveolar dead space. Avoid hypotension; target systolic blood pressure (SBP) >100 mmHg or mean arterial pressure (MAP) >60-65 mmHg. NIBP may overestimate SBP and MAP, especially in hypotensive or shocked patients-higher targets may be needed.

Hemodynamic stabilization and effective airway and ventilation management to prevent deviations from normal ranges are critical postresuscitation priorities in the prehospital setting, essential for preventing re-arrest and optimizing patient outcomes. Prehospital clinicians should be aware of the limitations of their monitoring equipment.