In-Hospital Cardiac Arrest: Current Management and Best Practices

Abstract

In-hospital cardiac arrest is a time-critical medical emergency associated with substantial mortality and neurological disability. Unlike out-of-hospital cardiac arrest, many in-hospital events are preceded by recognizable physiological deterioration, creating opportunities for prevention through structured monitoring, early warning systems, rapid response teams, and appropriate escalation of care. Once cardiac arrest occurs, outcomes depend on immediate recognition, activation of the hospital resuscitation system, high-quality cardiopulmonary resuscitation, early rhythm analysis, prompt defibrillation of shockable rhythms, appropriate pharmacologic treatment, and identification of reversible causes. Airway management should support oxygenation and ventilation without interrupting chest compressions, while capnography can assist in confirming airway placement and evaluating resuscitation quality. Following return of spontaneous circulation, treatment should focus on oxygenation and ventilation targets, hemodynamic stabilization, diagnosis and treatment of the arrest etiology, fever prevention, neurological monitoring, and delayed multimodal prognostication. Advanced interventions, including extracorporeal cardiopulmonary resuscitation and mechanical circulatory support, may benefit carefully selected patients in experienced centers but should not delay fundamental resuscitation measures. This review summarizes contemporary evidence and guideline recommendations for prevention, acute resuscitation, team organization, special circumstances, and post–cardiac arrest management after in-hospital cardiac arrest.