Post-cardiac arrest syndrome in adult hospitalized patients

  • Estivalis G. Acosta-Gutiérrez School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia.
  • Andrés M. Alba-Amaya School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia.
  • Santiago Roncancio-Rodríguez School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia.
  • José Ricardo Navarro-Vargas a. School of Medicine, Universidad Nacional de Colombia. Bogotá, Colombia. b. Hospital Universitario Nacional de Colombia, Universidad Nacional de Colombia. Bogotá, Colombia.
Keywords: Post-cardiac arrest syndrome, In-hospital cardiac arrest, Cardiopulmonary resuscitation, Return of spontaneous cardiac circulation, Ischemia-reperfusion injury


Adult In-hospital Cardiac Arrest (IHCA) is defined as the loss of circulation of an in-patient. Following high-quality cardiopulmonary resuscitation (CPR), if the return of spontaneous circulation (ROSC) is achieved, the post-cardiac arrest syndrome develops (PCAS). This review is intended to discuss the current diagnosis and treatment of PCAS. To approach this topic, a bibliography search was conducted through direct digital access to the scientific literature published in English and Spanish between 2014 and 2020, in MedLine, SciELO, Embase and Cochrane. This search resulted in 248 articles from which original articles, systematic reviews, meta-analyses and clinical practice guidelines were selected for a total of 56 documents. The etiologies may be divided into 56% of in-hospital cardiac, and 44% of non-cardiac arrests. The incidence of this physiological collapse is up to 1.6 cases/1,000 patients admitted, and its frequency is higher in the intensive care units (ICU), with an overall survival rate of 13% at one year. The primary components of PCAS are brain injury, myocardial dysfunction and the persistence of the precipitating pathology. The mainstays for managing PCAS are the prevention of cardiac arrest, ventilation support, control of peri-cardiac arrest arrythmias, and interventions to optimize neurologic recovery. A knowledgeable healthcare staff in PCAS results in improved patient survival and future quality of life. Finally, there is clear need to do further research in the Latin American Population.


Chen N, Callaway CW, Guyette FX, Rittenberger JC, Doshi AA, Dezfulian C, et al. Arrest etiology among patients resuscitated from cardiac arrest. Resuscitation. 2018;130:33-40. doi:

Mawani M, Kadir M, Azam I, Mehmood A, McNally B, Stevens K, et al. Epidemiology and outcomes of out-of-hospital cardiac arrest in a developing country-a multicenter cohort study. BMC Emergency Medicine. 2016;16(1). doi:

Al-Dury N, Rawshani A, Israelsson J, Stromsoe A, Aune S, Agerstrom J, et al. Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with emphasis on gender and age. Am J Emerg Med. 2017;35(12):1839-44. doi:

Schluep M, Gravesteijn BY, Stolker RJ, Endeman H, Hoeks SE. One-year survival after in-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2018;132:90-100. doi:

Bergum D, Haugen BO, Nordseth T, Mjolstad OC, Skogvoll E. Recognizing the causes of in-hospital cardiac arrest -- A survival benefit. Resuscitation. 2015;97:91-6. doi:

Chan P. Public health burden in in-hospital cardiac arrest. Institute of Medicine, Committee on the Treatment of Cardiac Arrest [internet]. 2013 [citado: 2019 oct. 23]. Disponible en:

Nichol G, Stiell IG, Hebert P, Wells GA, Vandemheen K, Laupacis A. What is the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med. 1999;6:95-102. doi:

Hamel MB, Phillips R, Teno J, Davis RB, Goldman L, Lynn J, et al. Cost effectiveness of aggressive care for patients with nontraumatic coma. Crit Care Med. 2002;30:1191-6. doi:

Riva G, Ringh M, Jonsson M, Svensson L, Herlitz J, Claesson A, et al. Survival in out-of-hospital cardiac arrest after standard cardiopulmonary resuscitation or chest compressions only before arrival of emergency medical services. Circulation. 2019;139(23):2600-9. doi:

Nolan J, Neumar R, Adrie C, Aibiki M, Berg R, Böttiger B, et al. Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication. Resuscitation. 2008;79(3):350-79. doi:

Soar J, Nolan J, Böttiger B, Perkins G, Lott C, Carli P, et al. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. 2015;95:100-47. doi:

Chang SH, Huang CH, Chih CL, Lee CC, Chang WT, Chen YT, et al. Who survives cardiac arrest in the intensive care units? J Critical Care. 2009;24:408-14. doi:

Navarro-Vargas JR. Registro de paro cardiaco en el adulto. Revista Facultad de Medicina Universidad Nacional de Colombia. 2005;53(3):196-203.

Mentzelopoulos S, Zakynthinos S. Post-cardiac arrest syndrome: pathological processes, biomarkers and vasopressor support, and potential therapeutic targets. Resuscitation. 2017;121:A12-4. doi:

Jiménez-Castro MB, Cornide-Petronio ME, Gracia-Sancho J, Peralta C. Inflammasome-mediated inflammation in liver ischemia-reperfusion injury. Cells. 2019;8:1131-57. doi:

Schein RMH, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to inhospital cardiopulmonary arrest. Chest. 1990;98(6):1388-92. doi:

Lai C, Wang C, Wang Y, Hsueh S, Ko W, Hsueh P. Global epidemiology of coronavirus disease 2019 (COVID-19): disease incidence, daily cumulative index, mortality, and their association with country healthcare resources and economic status. Int J Antimicrob Agents. 2020;55(4):105946. doi:

Morgan RW, Fitzgerald JC, Weiss SC, Nadkarni VM, Sutton RM, Berg RA. Sepsis-associated in-hospital cardiac arrest: Epidemiology, pathophysiology, and potential therapies. J Crit Care. 2017;40:128-35. doi:

Tran S, Deacon N, Minokadeh A, Malhotra A, Davis DP, Villanueva S, et al. Frequency and survival pattern of in-hospital cardiac arrests: The impacts of etiology and timing. Resuscitation. 2016;107:13-8. doi:

Jones D, Mercer I, Heland M, Detering K, Radford S, Hart G, et al. In-hospital cardiac arrest epidemiology in a mature rapid response system. Br J Hosp Med. 2017;78(3):137-42. doi:

Radeschi G, Mina A, Berta G, Fassiola A, Roasio A, Urso F, et al. Incidence and outcome of in-hospital cardiac arrest in Italy: a multicentre observational study in the Piedmont Region. Resuscitation. 2017;119:48-55. doi:

Rozen TH, Mullane S, Kaufman M, Frank-Hsiao YF, Warrillow S, Bellomo R, et al. Antecedentes to cardiac arrests in a teaching hospital intensive care unit. Resuscitation. 2013;85(3):411-7. doi:

Negovsky VA. The second step in resuscitation--the treatment of the 'post-resuscitation disease'. Resuscitation. 1972;1:1-7. doi:

Pothiawala S. Post-resuscitation care. Singapore Med J. 2017;58(7):404-7. doi:

Stub D, Bernard S, Duffy S, Kaye D. Post cardiac arrest syndrome. Circulation. 2011;123(13):1428-35. doi:

Navarro-Vargas J, Díaz J. Síndrome posparo cardiaco. Colombian Journal of Anesthesiology. 2014;42(2):107-13. doi:

Kalogeris T, Baines C, Krenz M, Korthuis R. Cell Biology of ischemia/reperfusion injury. Int Rev Cell Molecular Biol. 2012;(298):229-317. doi:

Morciano G, Giorgi C, Bonora M, Punzetti S, Pavasini R, Wieckowski M, et al. Molecular identity of the mitochondrial permeability transition pore and its role in ischemia-reperfusion injury. J Mol Cellular Cardiol. 2015;78:142-53. doi:

Crompton M. The mitochondrial permeability transition pore and its role in cell death. Biochemical J. 1999;341(2):233. doi:

Bukowska A, Lendeckel U, BodeBöger S, Goette A. Physiologic and pathophysiologic role of calpain: implications for the occurrence of atrial fibrillation. Cardiovasc Therapeut. 2010;30(3):e115-27. doi:

Momeni HR. Role of calpain in apoptosis. Cell J. 2011;13(2):65-72.

López Rodríguez MS. Protección cardiocerebral post paro cardiaco. Rev Cuba Anestesiol Reanim [internet]. 2010 [citado: 2019 ene. 7];9(3):150-60. Disponible en:

Schneider A, Böttiger BW, Popp E. Cerebral resuscitation after cardiocirculatory arrest. Anesth & Analg. 2009;108(3):971-9. doi:

Cassiani CA, Pérez AE, Vargas MC, Castro E, Osorio AF. Lesión cerebral posterior a paro cardiorrespiratorio. Acta Neurol Colomb. 2013;29(4):255-65.

Hernández H, López JB, Pérez JL, et al. Manejo del síndrome posparada cardiaca. Med Intensiva. 2010;34(2):107-26. doi:

Camici P, Prasad S, Rimoldi O. Stunning, hibernation, and assessment of myocardial viability. Circulation. 2008;117(1):103-14. doi:

Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest [published correction appears in N Engl J Med. 2002;346:1756]. N Engl J Med. 2002;346:549-56. doi:

Laurent I, Monchi M, Chiche JD, Joly LM, Spaulding C, Bourgeois B, et al. Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol. 2002;40:2110-6. doi:

Borsari Mauricio EC, Barbosa Teixeira MC, Assayag Batista RE, Pinto Okuno MF, Vancini Campanharo CR. Results of the implementation of integrated care after cardiorespiratory arrest in a university hospital. Rev Latino-Am. Enfermagem. 2018; 26:e2993. doi:

DeVita MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med. 2006;34:2463-78. doi:

Smith G. In-hospital cardiac arrest: Is it time for an in-hospital 'chain of prevention'? Resuscitation. 2010;81(9):1209-11. doi:

Smith G, Pitcher D. Prevention of cardiac arrest and decisions about cardiopulmonary resuscitation. Resucitation Council UK; 2010.

Johnson N, Carlbom D, Gaieski D. Ventilator management and respiratory care after cardiac arrest. Chest. 2018;153(6):1466-77. doi:

Peberdy M, Callaway C, Neumar R, Geocadin R, Zimmerman J, Donnino M et al. Part 9: post-cardiac arrest care: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 suppl 3):S768-86. doi:

Eastwood G, Nichol A, Wise M. Targeted therapeutic mild hypercapnia after cardiac arrest. Critical Care. 2017;21(1). doi:

Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med. 2013;369:2197-206. doi:

Salter R, Bailey M, Bellomo R, Eastwood G, Goodwin A, Nielsen N, et al. Changes in temperature management of cardiac arrest patients following publication of the target temperature management trial. Crit Care Med. 2018;46:1722-30. doi:

Taccone F, Picetti E, Vincent J. High quality targeted temperature management (TTM) after cardiac arrest. Critical Care. 2020;24(1). doi:

Nielsen N, Friberg H, Gluud C, Herlitz J, Wetterslev J. Hypothermia after cardiac arrest should be further evaluated--a systematic review of randomised trials with meta-analysis and trial sequential analysis. Int J Cardiol. 2011;151:333-41. doi:

García J, Jiménez-Brítez G, Flores-Umanzor E, Mendieta G, Freixa X, Sabaté M. Thrombotic and bleeding events after percutaneous coronary intervention in out-of-hospital cardiac arrest with and without therapeutic hypothermia. Revista Española de Cardiología (English Edition). 2019;72(5):433-5. doi:

Erath J, Hodrius J, Bushoven P, Fichtlscherer S, Zeiher A, Seeger F, et al. Early-onset-Pneumonien nach prähospitaler Reanimation. Medizinische Klinik - Intensivmedizin und Notfallmedizin. 2016;112(6):519-26. doi:

Sunde K. Hipotermia terapéutica en la parada cardiaca. Revista Española de Cardiología. 2013;66(5):346-9. doi:

Passi N, Oliver C, Dhadwal K. Hospital management of the post-cardiac arrest patient: priorities and challenges. Br J Hosp Med. 2019;80(2):C22-7. doi:

Faro J, Coppler P, Dezfulian C, Baldwin M, Molyneaux B, Urban A, et al. Differential association of subtypes of epileptiform activity with outcome after cardiac arrest. Resuscitation. 2019;136:138-45. doi:

Ettleson M, Arguello V, Wallia A, Arguelles L, Bernstein R, Molitch M. Hyperglycemia and insulin resistance in cardiac arrest patients treated with moderate hypothermia. J Clin Endocrinol Metabolism. 2014;99(10):E2010-4. doi:

Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, et al. Targeted temperature management at 33 ◦C versus 36 ◦C after cardiac arrest. N Engl J Med. 2013;369:2197-206. doi:

Pitcher D, Nolan J. Peri-arrest arrhythmias. Resuscitation Council UK. 2015;1:10-5.

Jumean M, Link M. Post-cardiac arrest arrhythmias. Oxford Medicine Online. 2016. doi:

Hadziselimovic E, Thomsen J, Kjaergaard J, Køber L, Graff C, Pehrson S, et al. Osborn waves following out-of-hospital cardiac arrest-Effect of level of temperature management and risk of arrhythmia and death. Resuscitation. 2018;128:119-25. doi:

Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010;81(10):1400. doi:

Soar J, Deakin CD, Nolan JP, Abbas G, Alfonzo A, Handley AJ, et al. European Resuscitation Council guidelines for resuscitation 2005: section 7. Cardiac arrest in special circumstances. Resuscitation. 2005;67:S135-70. doi:

Sreedharan J, Gourlay E, Evans MR, et al. Falsely pessimistic prognosis by EEG in post-anoxic coma after cardiac arrest: the borderland of nonconvulsive status epilepticus. Epileptic Disord. 2012;14:340-4. doi:

How to Cite
Acosta-Gutiérrez EG, Alba-Amaya AM, Roncancio-Rodríguez S, Navarro-Vargas JR. Post-cardiac arrest syndrome in adult hospitalized patients . Colomb. J. Anesthesiol. [Internet]. 2021 Mar. 11 [cited 2024 Feb. 28];50(1). Available from:


Download data is not yet available.
How to Cite
Acosta-Gutiérrez EG, Alba-Amaya AM, Roncancio-Rodríguez S, Navarro-Vargas JR. Post-cardiac arrest syndrome in adult hospitalized patients . Colomb. J. Anesthesiol. [Internet]. 2021 Mar. 11 [cited 2024 Feb. 28];50(1). Available from:
Narrative review


Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
QR Code

Some similar items: