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

Adult Post-ROSC (Return of Spontaneous Circulation) Care

Patient Safety Considerations

  1. Avoid hyperthermia
  2. Prehospital initiation of therapeutic hypothermia is not routinely recommended

Notes/Educational Pearls

Key Considerations      

  1. Hyperventilation is a significant cause of hypotension and recurrence of cardiac arrest in the post resuscitation phase and must be avoided
  2. Most patients immediately post resuscitation will require ventilatory assistance
  3. The condition of post-resuscitation patients fluctuates rapidly and continuously, and they require close monitoring. A significant percentage of post-ROSC patients will re-arrest
  4. A moderate number of post-ROSC patients may have evidence of ST elevation MI on EKG
  5. Common causes of post-resuscitation hypotension include hyperventilation, hypovolemia, and pneumothorax

Pertinent Assessment Findings

  1. Assess post-ROSC rhythm, lung sounds, and for signs of hypoperfusion

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914019 – Cardiac Arrest-Post Resuscitation Care

Key Documentation Elements

  • Immediate post-arrest rhythms, vital signs, oxygen saturation, neurologic status assessment
  • Post-ROSC 12-lead EKG

Performance Measures

  • Percent of ROSC patients transported to appropriate facility as defined by the EMS system

References

  1. Aufderheide TP, Lurie KG. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med. 2004;32(suppl):S345–51.
  2. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–63.
  3. Callaway CW, Donnino MW, Fink EL, et al. Part 8: Post cardiac arrest care: 2015 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S465-82.
  4. De Backer D et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362:779-89.
  5. Kim F, Nichol G, Maynard C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest. JAMA. 2014;311(1):45-52.
  6. Nolan JP, Neumar RW, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A scientific statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Circulation. 2008;79(3):350-79.
  7. Garot P, Lefevre T, Eltchaninoff H, et al. Six-month outcome of emergency percutaneous coronary intervention in resuscitated patients after cardiac arrest complicating ST-elevation myocardial infarction. Circulation. 2007;115(11):1354–62.
  8. Kim F, Nichol G, Maynard C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA. 2014;311(1):45-52.
  9. Kim F, Olsufka M, Longstreth WT Jr., et al. Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4°C normal saline. Circulation. 2007;115(24):3064–70.
  10. Kliegel A, Janata A, Wandaller C, et al. Cold infusions alone are effective for induction of therapeutic hypothermia but do not keep patients cool after cardiac arrest. Resuscitation. 2007;73(1):46–53.
  11. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med. 2013;369(23):2197-206.
  12. Oddo M, Schaller MD, Feihl F, Ribordy V, Liaudet L. From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med. 2006;34(7):1865–73.
  13. Quintero-Moran B, Moreno R, Villarreal S, et al. Percutaneous coronary intervention for cardiac arrest secondary to ST-elevation acute myocardial infarction: influence of immediate paramedical/medical assistance on clinical outcome. J Invasive Cardiol. 2006;18(6):269–72.
  14. Vereczki V, Martin E, Rosenthal RE, Hof PR, Hoffman GE, Fiskum G. Normoxic resuscitation after cardiac arrest protects against hippocampal oxidative stress, metabolic dysfunction, and neuronal death. J Cereb Blood Flow Metab. 206;26(6):821-35.
  15. Virkkunen I, Yli-Hankala A, Silfvast T. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer’s solution: a pilot study. Resuscitation. 2004;62(3):299–302.