Skip to main content
  • Letter to the Editor
  • Open access
  • Published:

Type of post-cardiac arrest rhythm should not be labelled

Global resuscitation bodies recommend that when a cardiac arrest victim develops a return of spontaneous circulation (ROSC), they should be treated as per post-cardiac arrest protocol (Perkins et al. 2021). According to the post-cardiac arrest care protocol, the patient's airway should be secured if they do not have an intact sensorium and should not be hyperventilated (target end-tidal CO2 35–40 mmHg). If the patient has hypotension [systolic blood pressure (SBP) < 90 mmHg], should treat that with 20–30−1 bolus of intravenous (IV) fluid, preferably with crystalloid. If hypotension persists even after crystalloid administration, then vasopressor/inotropic infusion can be considered to maintain SBP above 90 mmHg (Link et al. 2015). Once the organised electrical activity returns during cardiopulmonary resuscitation (CPR), the carotid pulse should be checked. If the carotid pulse is absent (in the presence of organised electrical activity), then the patient should be treated as having a pulseless electrical activity (PEA), and the CPR should be continued (Link et al. 2015). If the carotid pulse is present, the patient has obtained ROSC and should be treated as per post-cardiac arrest protocol to prevent the recurrence of cardiac arrest. The possibility of arrhythmias after cardiac arrest is common, and arrhythmias are due to but not limited to ischemia–reperfusion injury, post-cardiac arrest syndrome, dyselectrolytemia, metabolic acidosis due to coronary arterial disease, and exogenous administration of adrenaline (Bellut et al. 2019; Al-Khatib et al. 2018). Type of heart’s rhythm of post-cardiac arrest victims should not be labelled. If hypotension is present after ROSC, that needs to be treated with IV fluids or vasopressor/inotropic therapy. The treatment of choice for stable tachyarrhythmias is pharmacological therapy; for unstable tachyarrhythmias, it is electrical therapy (synchronized cardioversion). The pharmacological treatment for tachyarrhythmias, in brief, includes adenosine (for stable, regular narrow complex tachyarrhythmia), \(\upbeta\)-blockers, calcium channel blockers (for stable, irregular narrow complex tachyarrhythmia), and amiodarone (for stable, regular wide complex tachyarrhythmia) (Perkins et al. 2021). Labelling the type of heart rhythm which recovered from cardiac arrest may mandate the administration of \(\upbeta\)-blocker or calcium channel blockers depending upon the type of rhythm of a patient who just recovered from cardiac arrest, and that can lead to the development of recurrent, refractory cardiac arrest (due to blockade of \(\upbeta\)-receptors). Probable causes for developing cardiac arrest should be recognised (hypoxia, hypovolemia, hypothermia, hypo/hyperkalaemia, acidosis, toxins, cardiac tamponade, tension pneumothorax, coronary, and pulmonary thromboembolism) and treated accordingly, which helps in preventing recurrence of cardiac arrest (Perkins et al. 2021; Link et al. 2015). For a patient with a higher heart rate (HR) > 150 min−1 with hypotension after ROSC, infusion of an agent which has a lesser positive chronotropic effect (either noradrenaline or phenylephrine infusion) may be considered. In case of hypotension concomitant with bradyarrhythmia (HR < 50 min−1), infusions of positive chronotropic agents (adrenaline infusion) should be considered (Fig. 1).

Fig. 1
figure 1

Choosing the appropriate vasopressor/inotropic agent to treat hypotension after recovering from cardiac arrest (rather than treating tachycardia as per the tachycardia algorithm). ROSC: return of spontaneous circulation; BP: blood pressure; HR: heart rate

To conclude, the heart’s rhythm recovered from cardiac arrest should not be labelled. Hypotension following ROSC should be treated with IV fluids, and if it persists even after fluid resuscitation, then vasopressor (for patients with HR > 150 min−1) or inotropic agent (for patients with HR < 50 min−1) should be started to maintain systemic blood pressure.

Availability of data and materials

Not applicable.



Return of spontaneous circulation


Heart rate




Cardiopulmonary resuscitation


Systolic blood pressure


Pulseless electrical activity


  • Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB et al (2018) 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart rhythm society. J Am Coll Cardiol 72(14):e91-220

    Article  PubMed  Google Scholar 

  • Bellut H, Guillemet L, Bougouin W, Charpentier J, Ben Hadj Salem O, Llitjos JF et al (2019) Early recurrent arrhythmias after out-of-hospital cardiac arrest associated with obstructive coronary artery disease: analysis of the PROCAT registry. Resuscitation 141:81–87

    Article  PubMed  Google Scholar 

  • Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK et al (2015) Part 7: adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132(18 Suppl 2):S444-464

    PubMed  Google Scholar 

  • Perkins GD, Graesner JT, Semeraro F, Olasveengen T, Soar J, Lott C et al (2021) European resuscitation council guidelines 2021: executive summary. Resuscitation 161:1–60

    Article  PubMed  Google Scholar 

Download references




Not applicable.

Author information

Authors and Affiliations



SS contributed to the investigation, resources, data curation, writing—original draft, writing—review and editing. MS contributed to term, conceptualization, methodology, investigation, resources, data curation, writing—original draft, writing—review and editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Muthapillai Senthilnathan.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Suganya, S., Senthilnathan, M. Type of post-cardiac arrest rhythm should not be labelled. Ain-Shams J Anesthesiol 15, 93 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: