Heart 5 · 16 min · ground

ROSC — the heart is the lung's neighbor

AHA 2025 · 90–98% (AHA 2025 post-ROSC; 100% until a sat can be measured) · 6 mL/kg PBW (4–8) · Pplat ≤30 · ΔP ≤14 (trainer) · PaCO2 ~35–45

58-year-old anterior STEMI, 18 minutes down, ROSC after two shocks. Cold, wet, sat 88%, MAP 62 on norepinephrine and a dab of epi.

Handoff

Cardiogenic shock plus pulmonary edema. PEEP helps the LV and hurts the RV. You have to pick a number and watch the MAP.

1
PEEP 8–12 — help the LV without killing MAP
Too little: foam. Too much: no blood back to the left heart.
2
SpO2 90–98% once the probe reads (AHA 2025)
100% until a sat can be measured. Then wean off 100%. Do not slam to 40%.
3
Don't over-ventilate a fresh ROSC
PaCO2 40–45, not 28. The brain just had a bad day too.

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