Care in the Hospital

What to expect during hospitalization after cardiac arrest

Treatments and clinical courses in the hospital are different for every person and every family after cardiac arrest. Time spent in the intensive care unit (ICU) and inpatient floors may last for days to weeks. Your loved one may have received procedures in the ICU or just before discharge and learned about new medical conditions or worsening of previous ones. This article is a general overview of hospital care after cardiac arrest.

The type of care a survivor can expect after cardiac arrest can vary greatly depending on where the cardiac arrest occurred and the type of treatment and support they require.

Out-of-hospital cardiac arrest (OHCA)

If your loved one had a cardiac arrest outside of the hospital, they must have been brought to a hospital emergency department (ED) by emergency medical services after they were provided immediate care. 

In the ED, to help with breathing, your loved one might have had a breathing tube placed. Intravenous catheters were placed in their veins, and medications were infused through them to support their heart and blood pressure. They may have received blood work and imaging tests (e.g., X-rays, computed tomography/CT/CAT scans, or ultrasound scans) to understand their heart and brain. Your loved one may have also received cooling treatment (also known as targeted temperature management, therapeutic hypothermia, or code chill), a treatment to cool the body and help the heart and brain recover. They may also have received medications to keep them comfortable.

One of the other emergent treatments is cardiac catheterization or angiography of the heart, where a dye is injected to see if there is a blockage of one or more of the arteries supplying the heart with blood, which could have caused the cardiac arrest. These blockages can be opened up by a procedure, if necessary. From here, depending on what medications and other treatments your loved one needs, they are admitted to the ICU or another hospital unit.

In-hospital cardiac arrest (IHCA)

If your loved one had a cardiac arrest in the hospital, such as during a surgery, heart procedure, or hospitalization for another reason (e.g., pneumonia, sepsis, pregnancy), it is highly likely they were moved to the ICU once their heart started beating again. Just like people who have a cardiac arrest outside the hospital, your loved one may have needed various tubes, lines, and procedures.

Intensive care unit (ICU)

Most but not all people who are admitted to the ICU have a breathing tube put down their throat and require support from a breathing machine (ventilator). With this in place, your loved one will probably be given medications to keep them sleepy (sedation) and comfortable (analgesics). They will likely have a tube (a “Foley”) in their bladder to help them urinate and to help the team keep track of their fluid output (how much is going in versus how much is going out). Your loved one will also have several IVs, used for medications.

There will be many monitors and alarms that the survivor hears, alerting their care team to any changes in heart rate, heart rhythm, blood pressure, oxygen levels, etc. Your loved one’s care team will keep a close eye on their organ functions and intervene as needed.

Your loved one will not be able to eat normally if they have a breathing tube. Food or nutrition may be given through a tube put through their mouth that ends in the stomach or small intestine. Once a breathing tube is removed, diet options will progress from clear liquids to, eventually, solid food, assuming there are no issues with the patient’s ability to swallow.

Some people are very sick and end up needing a different breathing tube placed through a hole in the front of their neck. This is called a tracheostomy, and it is a surgical procedure. This type of breathing tube is used to prevent long-term damage to the survivor’s voice box (larynx) and windpipe (trachea) that can occur when they have a breathing tube for a long time. This tracheostomy tube placed through the hole in the neck can eventually be removed. Likewise, some people need a feeding tube for long-term nutrition. In this case, the feeding tube is placed through a small hole in the belly so that the tube goes into the stomach or small intestine. This avoids having any tubes in the nose or mouth long-term, which can cause other complications.

In the ICU, the patient does not move much. Their muscles can become weak or stiff very quickly. The care team can reduce the risk of weakness or stiffness by helping the patient move earlier and more frequently, even if they’re stuck in bed with a breathing machine.

Your loved one’s care team will work together to determine when they are ready for the breathing tube to be removed safely. This will depend on many factors. Sometimes the patient can develop a lung infection (pneumonia) after several days on the ventilator. This is treated with antibiotics and could prolong their need for the breathing tube. 

Some people also require dialysis or kidney “support” during the ICU stay. The medical care team will determine if this is necessary.

Many people who are comatose after cardiac arrest have continuous brain monitoring, known as electroencephalogram (EEG). This technology helps the medical care team determine if the survivor is having any seizures or if there is evidence of normal brain activity. 

Throughout the patient’s initial days in the ICU, their care team will search for the reason the cardiac arrest happened and how to prevent it from happening again.

Is it possible to not wake up after a cardiac arrest?

Some people never wake up after cardiac arrest. Specialized tests can be used to determine an estimate of whether someone will wake up. No test is perfect or absolute. Sometimes people wake up in a couple of days, sometimes in a couple of weeks, and sometimes not at all. Discussions regarding how long to wait or when to withdraw care are sometimes necessary.

Step-down unit

Normally, people are transferred out of the ICU to a step-down unit if they still have a high need for skilled nursing care. Step-down units are considered intermediate units between the ICU and general medical (”floor”) units. Most people here have improved enough to not need breathing tubes or other advanced medical therapies, but they still need frequent checks of their vital signs (heart rate, blood pressure, etc.) and neurological status, although criteria may vary between hospitals.

General medical (”floor”) unit

A general medical or surgical ward or unit has many more patients than medical care team members. This means that people here have improved enough to do more things for themselves and require less monitoring. Criteria for being transitioned to a general floor may vary.

Family or visitors in the hospital

Visitation policies vary widely between hospitals. Families are essential for supporting recovery and helping to care for hospitalized people. It can get overwhelming to have frequent visitors in the hospital, as the patient’s brain and body may require rest after procedures, therapies, and quality time with their immediate family. Sometimes limiting who comes, how often, and at what time of day is needed. The care team can be helpful with navigating when the survivor needs rest and when they might be available for visits.

Support for family/health advocates

Formal support for family and health advocates may feel scarce during your loved one’s hospital stay and after. The care team, including social workers and chaplains, may be able to provide support and should provide guidance or expectations for loved ones. However, the care team’s focus will ultimately be on the patient. More work is being done to address the need for family support in the hospital while the survivor is very sick. Some hospitals can connect survivors and family members with other survivors or families who have been through similar experiences. Not all hospitals have this available at this time, but the Heartsight initiative is trying to fill this gap.

Thank you to our contributors

Kelly Sawyer & Samantha Fernandez