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. You 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 you can expect after cardiac arrest can vary greatly depending on where the cardiac arrest occurred and the type of treatment and support you require.

Out-of-hospital cardiac arrest (OHCA)

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

In the ED, to help with breathing, you might have had a breathing tube placed. Intravenous catheters were placed in your veins, and medications were infused through them to support your heart and blood pressure. You may have received blood work and imaging tests (e.g., X-rays, computed tomography/CT/CAT scans, or ultrasound scans) to understand your heart and brain. You 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. You may also have received medications to keep you 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 you need, you were admitted to the ICU or another hospital unit.

In-hospital cardiac arrest (IHCA)

If you 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 you were moved to the ICU once your heart started beating again. Just like people who have a cardiac arrest outside the hospital, you 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, you will probably be given medications to keep you sleepy (sedation) and comfortable (analgesics). You will likely have a tube (a “Foley”) in your bladder to help you urinate and to help the team keep track of your fluid output (how much is going in versus how much is going out). You will also have several IVs, used for medications.

There will be many monitors and alarms that you hear, alerting your care team to changes in your heart rate, heart rhythm, blood pressure, oxygen levels, etc. Your care team will keep a close eye on your organ functions and intervene as needed.

You will not be able to eat normally if you have a breathing tube. Food or nutrition may be given through a tube put through your 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 your 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 your voice box (larynx) and windpipe (trachea) that can occur when you 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, you do not move much. Your muscles can become weak or stiff very quickly. Your care team can reduce the risk of weakness or stiffness by helping you move earlier and more often, even if stuck in bed with a breathing machine.

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

Some people also require dialysis or kidney “support” during the ICU stay. Your 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 your medical care team determine if you are having any seizures or if there is evidence of normal brain activity. 

Throughout your initial days in the ICU, your 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 your brain and body may require rest after procedures, therapies, and quality time with your immediate family. Sometimes limiting who comes, how often, and at what time of day is needed. Your care team can be helpful with navigating when you need rest and when you might be available for visits.

Support for family/health advocates

Formal support for family and health advocates may feel scarce during your hospital stay and after. Your care team, including social workers and chaplains, may be able to provide support and should provide guidance or expectations for your family. However, the care team’s focus will be on you, the patient. More work is being done to address the need for family support in the hospital while you are very sick. Some hospitals can connect you and your family 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