Return of Spontaneous Circulation Management

Question 1

What are the primary aims of ROSC management?

Answer 1

1. Primary aims after a ROSC:
   - Support circulation, airway & breathing
   - Maintain cerebral perfusion
   - Manage cardiac dysrhythmias
2. Determine & manage the cause of the cardiac arrest giving consideration to those that are reversible

Question 2

What are the reversible causes of cardiac arrest?

Answer 2

1. Hypoxia
2. Hypo/hyperthermia
3. Hypovolaemia
4. Hypo/hyperkalaemia
5. Hydrogen ion (acidosis)
6. Tension pneumothorax
7. Tamponade
8. Toxins
9. Thrombosis

Question 3

Outline the standard protocol for ROSC management.

Answer 3

1. Standard cares
2. 12-lead ECG
3. Treat presenting dysrhythmias
4. Consider & manage reversible causes
5. Optimise ventilation & oxygenation:
   - Maintain SPO2 >94%
   - Consider advanced airway
   - Maintain ETCO2 of 30-40
   - If no ETCO2, ventilate at a rate of 8-12/min
   - Do not hyperventilate
6. Optimise circulation:
   - Aim for SBP >100 for adults
   - Aim for SBP >80 for children
7. Consider:
   - Posturing
   - Adrenaline