Post-arrest Management

The preferred disposal for your patient with recovery of spontaneous circulation from anaphylaxis-induced cardiac arrest is intensive care.

In the meantime:

  • Start a titrated adrenaline infusion — follow local policy.
  • Insert an arterial line to guide therapy
  • Give 200 mg IV hydrocortisone and 10 mg chlorpheniramine (slowly) if these have not already been administered
  • Measure the serum tryptase level (in a standard U&Es bottle) labelling the time carefully.  Arrange repeat measurement 1-2 hours later, in order to help confirm true anaphylaxis. Ideally a sample after 24 hours or in convalescence (eg at follow up clinic) should be taken as some people have elevated baseline levels [1]
  • Consider targeted temperature management as per local guidelines in patients not regaining consciousness
  • Document the need for in-hospital teams to arrange the following for your patient — Medic alert bracelet, auto-injector (and education in its use and administration) and referral to an immunologist

  • Remember that a biphasic reaction can recur many hours later
  • In cases of drug-induced anaphylaxis, report the incident to the Medicines and Healthcare products Regulatory Agency (MHRA) using the yellow card scheme (  The BNF includes copies of the yellow card at the back of each edition

Learning bite

Measure the serum tryptase level post-resuscitation and 1-2 hours later to help confirm true anaphylaxis.

Survivors of peri-arrest anaphylaxis require a Medic alert bracelet, adrenaline auto-injector (provision and education) and referral to an immunologist.