Return of Spontaneous Circulation

Question 1

What is ROSC?

Answer 1

Return of spontaneous circulation

ROSC is the resumption of a sustained heart rhythm that perfuses the body after cardiac arrest

Question 2

What are the common signs and symptoms associated with ROSC?

Answer 2

Commonly associated with significant respiratory effort

Signs of include breathing, coughing, or movement and a palpable pulse or a measurable blood pressure

Question 3

Order of operations after ROSC is achieved?

Answer 3

Prepare for transfer
Airway and breathing
Circulation
ECG
Temperature
BM
Other

Question 4

How should a patient be prepared for transfer after achieving ROSC?

Answer 4

1. Early recurrence of VF is common ensure appropriate ongoing monitoring through defibrillator pads
2. Transfer patient directly to the nearest appropriate hospital in accordance with local pathways
3. Provide an ATMIS pre-alert call to the receiving facility

Question 5

What is VF?

Answer 5

Ventricular fibrillation
Myocardial cells depolarise and depolarise with no organisation, ‘disorganised ‘electrical activity’
Pulseless

Question 6

How should you maintain airway and breathing after achieving ROSC?

Answer 6

1. Ensure an effective airway; consider enhanced support
2. Record and maintain oxygen saturations of 94-98%
3. Monitor waveform capnography
4. Ventilate lungs to normocarbia (4.6-6.0 kPa)

Question 7

normocarbia?

Answer 7

a state of normal arterial carbon dioxide pressure

Question 8

How should you maintain adequate circulation after achieving ROSC?

Answer 8

1. Record blood pressure and aim for SBP > 80mmHg
2. First: Fluid (crystalloid) - restore normovolaemia
3. Second: Consider vasopressor/inotrope to maintain SBP unresponsive to fluid resuscitation as per local guideline e.g. adrenaline
4. In the event of symptomatic bradycardia, atropine should be administered

Question 9

Bradycardia?

Answer 9

Abnormally slow heart rate

Question 10

What ECG should you perform after ABC is completed post achievement of ROSC?

Answer 10

12-lead ECG

Question 11

How should temperature be maintained after achieving ROSC?

Answer 11

1. Measure temperature

2. Patients post-ROSC should be allowed to cool passively

Question 12

normovolaemia?

Answer 12

Normal blood (or intravascular fluid) volume

Question 13

What should be performed after ensuring adequate temperature in a patient post-ROSC?

Answer 13

BM

Measure and record blood glucose, checking for hypo/hyperglycaemia

Question 14

What other considerations should be taken in the treatment of a patient post-ROSC?

(Do not include; airway, breathing, circulation, ECG, temperature or BM)

Answer 14

Consider the provision of analgesia for the management of pain
Seizures that do not self-terminate within five minutes may be treated with a benzodiazepine
Combative patients may benefit from anaesthetic management or sedation, consider advanced care

Question 15

What analgesia may be given to a patient post-ROSC?

Answer 15

Small dose opiates or IV paracetamol