What is the first intervention recommended per REMAC for post-ROSC hypotension with a SBP of 80 mmHg?

The recommended first intervention for post-ROSC hypotension with a systolic blood pressure of 80 mmHg is a 500 mL normal saline (NS) bolus. This approach is grounded in the understanding that restoring intravascular volume quickly can be critical in managing hypotension following a cardiac arrest event. The administration of a fluid bolus aims to improve cardiac output and enhance organ perfusion, which is essential in stabilizing patients who have just achieved return of spontaneous circulation (ROSC).

In cases of post-ROSC hypotension, initiating fluid resuscitation alleviates potential hypovolemia and helps counteract any vasodilation that may occur as part of the post-cardiac arrest syndrome. The choice of normal saline is based on its wide availability, effectiveness in quickly increasing the circulating volume, and compatibility with most patients.

Other interventions may be necessary in subsequent steps or if fluid resuscitation alone does not improve blood pressure, but the initial bolus represents a standard first-line treatment in this context, emphasizing the importance of addressing immediate hemodynamic instability. The other options listed either provide alternative treatments that are typically not the first line for hypotension or pertain to different aspects of care that would usually follow the initial