The best chance of survival with a good neurological outcome after
cardiac arrest is afforded by early recognition and high-quality
cardiopulmonary resuscitation (
CPR), early defibrillation of
ventricular fibrillation (VF), and subsequent care in a specialist center. Compression-only
CPR should be used by responders who are unable or unwilling to perform mouth-to-mouth ventilations. After the first
defibrillator shock, further rhythm checks and defibrillation attempts should be performed after 2 min of
CPR. The underlying cause of
cardiac arrest can be identified and treated during
CPR. Drugs have a limited effect on long-term outcomes after
cardiac arrest, although
epinephrine improves the success of
resuscitation, and
amiodarone increases the success of defibrillation for refractory VF. Supraglottic airway devices are an alternative to tracheal intubation, which should be attempted only by skilled rescuers. Care after
cardiac arrest includes controlled reoxygenation,
therapeutic hypothermia for
comatose survivors,
percutaneous coronary intervention, circulatory support, and control of
blood-glucose levels and
seizures. Prognostication in
comatose survivors of
cardiac arrest needs a careful, multimodal approach using clinical and electrophysiological assessments after at least 72 h.