After resuscitation from a cardiac arrest, circulation has returned but the patient remains unconscious. Which intervention is primarily used to protect neurological function?

• A. Immediate coronary angiography
• B. High-dose steroids
• C. Rapid fluid bolus
• D. Targeted temperature management (TTM)

Answer: (D)

Protecting the brain after circulation returns is the primary goal when a patient remains unconscious. Cooling the patient to a targeted temperature (commonly 32–36°C) for a period of time directly mitigates brain injury by lowering the brain’s metabolic demands, reducing excitotoxic neurotransmitter release, dialing down inflammatory and free‑radical processes, and limiting cellular damage during reperfusion. This neuroprotective strategy has been shown to improve neurologic outcomes after cardiac arrest.

Other options may be important for overall care but do not primarily shield the brain. Urgent coronary angiography treats the underlying cardiac cause, not the immediate protection of neural tissue. High‑dose steroids haven’t demonstrated a clear neuroprotective benefit in this situation. A rapid fluid bolus might help circulation in some contexts but can worsen cerebral edema or disrupt cerebral perfusion if not indicated. Targeted temperature management is the intervention most specifically aimed at preserving neurological function after resuscitation.