Adult Post-ROSC (Return of Spontaneous Circulation) Care

Table of Contents

Aliases

None noted

Patient Care Goals

Out-of-hospital cardiac arrest in the U.S. has a mortality rate greater than 90% and results in excess of 300,000 deaths per year. Many of those who do survive suffer significant neurologic morbidity. Current research has demonstrated that care of patients with return of spontaneous circulation (ROSC) at specialized centers is associated with both decreased mortality and improved neurologic outcomes.

The goal is therefore to optimize neurologic and other function following a return of spontaneous circulation following resuscitated cardiac arrest.

Patient Presentation

Inclusion Criteria

Patient returned to spontaneous circulation following cardiac arrest resuscitation

Exclusion Criteria

None recommended

Patient Management

Assessment, Treatment, and Interventions

  1. If scene allows, do not move patient from current location for 10 minutes
    1. Patients are at high risk for going back into cardiac arrest
  2. Perform general patient management
  3. Support life-threatening problems associated with airway, breathing, and circulation. Monitor closely for reoccurrence of cardiac arrest
  4. Administer oxygen as appropriate with a target of achieving 94-98% saturation. Do not hyperoxygenate
  5. Do not hyperventilate. Maintain a ventilation rate of 6-8 per minute and ETCO2 of 30-40 mmHg
  6. For hypotension (SBP less than 90 mmHg or MAP less than 65) [see Shock guideline]
  7. Perform 12-lead EKG
    1. If STEMI present, follow TCD plan for STEMI
  8. Check blood glucose
    1. If hypoglycemic, treat per Hypoglycemia guideline
    2. If hyperglycemic, notify hospital on arrival
  9. If patient seizes, treat per Seizures guideline
  10. Consider transport patients to facility which offers specialized post-resuscitative care
  11. Do not allow patient to become hyperthermic
    1. Use passive cooling measures only

Notes – Adult Post-ROSC (Return of Spontaneous Circulation) Care