CARDIOPULMONARY RESUSCITATION: Edited by Fabio S. TacconeOptimal ventilator settings after return of spontaneous circulationEastwood, Glenn M.a,b; Nichol, Alistaira,c,dAuthor Information aAustralian and New Zealand Intensive Care Research Centre, Melbourne bDepartment of Intensive Care, Austin Hospital, Heidelberg cDepartment of Intensive Care, Alfred Hospital, Prahran, Victoria, Australia dUniversity College Dublin Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland Correspondence to Glenn M. Eastwood, RN, BN, BN (Hons), GradDip (Crit Care), PhD, Research Manager, Department of Intensive Care, Austin Hospital, Heidelberg 3084, VIC, Australia. Tel: +61 3 9496 4835; fax: +61 3 9496 3932; e-mail: [email protected] Current Opinion in Critical Care: June 2020 - Volume 26 - Issue 3 - p 251-258 doi: 10.1097/MCC.0000000000000720 Buy Metrics Abstract Purpose of review To describe current practice, recent advances in knowledge and future directions for research related to the post return of spontaneous circulation (ROSC) ventilatory management of cardiac arrest patients. Recent findings Out-of-hospital cardiac arrest (OHCA) is a major public health problem with an estimated incidence of approximately one per 1000 persons per year. A priority of intensive care management of resuscitated OHCA patients is to reduce secondary reperfusion injury. Most OHCA patients are mechanically ventilated. Most of these require mechanical ventilation as they are unconscious and for oxygen (O2) management and carbon dioxide (CO2) control. Low levels of O2 and CO2 following OHCA is associated with poor outcome. Recently, very high fraction of inspired oxygen has been associated with poor outcomes and elevated CO2 levels have been associated with improved neurological outcomes. Moreover, it is increasingly being appreciated that the ventilator may be a tool to adjust physiological parameters to enhance the chances of favourable outcomes. Finally, ventilator settings themselves and the adoption of protective ventilation strategies may affect lung–brain interactions and are being explored as other avenues for therapeutic benefit. Summary Current evidence supports the targeting of normal arterial O2 and CO2 tensions during mechanical ventilation following ROSC after cardiac arrest. Use of protective lung strategies during mechanical ventilation in resuscitated cardiac arrest patients is advocated. The potential therapeutic benefits of conservative O2 therapy, mild hypercapnia and the optimal ventilator settings to use post-ROSC period will be confirmed or refuted in clinical trials. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.