A comatose 58-year-old man achieves ROSC after out-of-hospital ventricular fibrillation arrest. He is intubated and ventilated. The recommended arterial blood oxygenation target during the immediate post-resuscitation phase is:
- A PaO2 above 150 mmHg to guarantee cerebral oxygen delivery
- B SpO2 88 to 92 percent to avoid oxidative injury
- C SpO2 94 to 98 percent, titrating inspired oxygen to avoid both hypoxaemia and hyperoxaemia ✓
- D SpO2 100 percent on FiO2 1.0 until neurological recovery
Correct answer: C. SpO2 94 to 98 percent, titrating inspired oxygen to avoid both hypoxaemia and hyperoxaemia
Explanation
After ROSC, inspired oxygen should be titrated to an SpO2 of 94 to 98 percent, avoiding PaO2 below 60 mmHg and unnecessary hyperoxaemia. Experimental data associate hyperoxia with increased oxidative injury and worse neurological outcome, which eliminates option A and D. Deliberate hypoxaemia to 88 to 92 percent is harmful and has never been endorsed in this setting.
Reference: AHA Guidelines for CPR and Emergency Cardiovascular Care, 2020 ed.
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Written and medically reviewed by the StethoPrep medical team.