For ROSC patients, what capability must a definitive care hospital have?

• A. ECMO capability
• B. Neurosurgery on-call
• C. Targeted temperature management
• D. Interventional radiology

Answer: (C)

Targeted temperature management is the capability a definitive care hospital must have for ROSC patients. After circulation returns, the brain is highly vulnerable to injury from the arrest and the reperfusion process. Lowering and maintaining the patient’s body temperature within a specific range reduces metabolic demand, limits inflammatory and reperfusion damage, and improves chances of better neurological outcomes. A facility with this capability can promptly initiate cooling or controlled cooling methods, continuously monitor core temperature, and manage the necessary support like sedation, analgesia, and airway/ventilation while ensuring a safe, gradual rewarming plan. Fever avoidance is also a key part of this protection.

Other options—like ECMO, neurosurgery on-call, or interventional radiology—are important in particular scenarios but are not universally required for all ROSC patients. The universal post-arrest protection focus is on implementing targeted temperature management.