Pitfalls

All critically-ill patients demand physician presence at the bedside so that rapid reassessment of clinical response to interventions can be made. They cannot be managed ‘from afar’.
Post-arrest patients have a conflicting need to perfuse the post-ischaemic brain without too much strain on the post-ischaemic heart.
The need for adequate sedation must be balanced against the risk of worsening cardiovascular instability.
An unconscious patient is at great risk of unrecognised hypoglycaemia, so cautious glycaemic control is preferred.
Pyrexia is common post-arrest and must be avoided – it correlates with a worse neurological outcome.
Absent pupillary reflexes and absent motor response to pain are of no prognostic value soon after ROSC (but are of value at 72 hours).
Advanced age does NOT predict poorer neurological outcome in patients with ROSC post-cardiac arrest.
a pH lower than 7.05 is associated with a worse outcome post-ROSC.
The perception of a poor outcome being likely may well affect the resuscitative teams’ efforts and become a ‘self-fulfilling prophecy’.