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Post-Cardiac Arrest PaCO2 Target — FRCA Final MCQ

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ModerateIntensive Care MedicinePost-Cardiac Arrest PaCO2 TargetFRCA Final

A 60-year-old man (ASA III) is admitted to ICU after out-of-hospital cardiac arrest with ROSC achieved after 15 minutes of CPR. He is intubated and ventilated. Current guidelines recommend targeting which PaCO2 range during the post-resuscitation period?

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Correct answer: C — >8.0 kPa (significant hypercarbia)

Post-cardiac arrest, normocarbia (PaCO2 4.5-6.0 kPa, 35-45 mmHg) is the target. Both hypocarbia and hypercarbia are harmful: hypocarbia causes cerebral vasoconstriction, reducing cerebral blood flow to already ischaemic brain tissue. Hypercarbia causes cerebral vasodilation, potentially worsening cerebral oedema and raised ICP. The Resuscitation Council UK 2021 guidelines specifically recommend targeting normoxia (SpO2 94-98%, avoid hyperoxia) and normocarbia in the post-resuscitation phase.

Reference: Resuscitation Council UK – 2021 – Post-resuscitation care; ERC/ESICM – 2021 – Post-resuscitation guidelines