Ep 216 Cardiac Arrest Update: Beyond the 2025 ACLS Guidelines Part 2 – Medications, Airway, Termination and Post-ROSC Care

Cardiac arrest management requires moving beyond standard algorithms to address complex clinical scenarios through physiological judgment and evidence-based decision-making. Vasopressors like norepinephrine serve as the primary post-ROSC hemodynamic support, while push-dose epinephrine acts as a critical bridge. Antiarrhythmics, specifically amiodarone and lidocaine, demonstrate greater efficacy when administered early rather than waiting for late-stage shocks. Airway management prioritizes continuous chest compressions, favoring supraglottic devices in pre-hospital settings and endotracheal intubation in controlled environments. Waveform capnography provides essential real-time feedback on CPR quality and ROSC status. Termination of resuscitation decisions integrate the University of Toronto criteria with clinical gestalt, end-tidal CO2 trends, and POCUS findings, such as cardiac standstill. Finally, targeted temperature management and whole-body CT imaging post-ROSC help identify reversible causes and optimize neurological outcomes in critically ill patients.