Cardiac arrest month: Patient management post-ROSC

EEAST RRVs and amb on scene

Needless to say, cardiac arrests are stressful events for all concerned.

If a return of spontaneous circulation (ROSC) is achieved this is of course a good achievement, but this is only the first step towards achieving a long term positive outcome. Post-resuscitation care is one area of cardiac arrest management that appears to get little acknowledgement, despite the evidence supporting it as one of the main elements of post-ROSC survival. Without adopting a systematic approach in the management of your patient at this time, it may well increase the likelihood of another cardiac arrest.

Here we take a look at areas of post-resuscitation care that can really optimise survival chances:

  • If a ROSC is achieved, do not look to move the patient for at least 10 minutes; this is the period where they are most likely to re-arrest, so it’s not a race to A&E. Use the time to perform the checks below, and plan extrication. There will of course be exceptions to this, namely traumatic cardiac arrests (TCA) where rapid removal must be considered
  • Consider critical care desk (CCD) involvement to meet the needs of the patient, e.g. sedation
  • During the 10-minute period, do an ABCDE assessment of the patient and document all findings. Pay particular attention to ABC, and, if possible, try and correct any abnormal findings
  • Try to establish a clinical impression as to why the patient went into cardiac arrest; during an arrest we look at reversible causes, but it’s also worth trying to get a working diagnosis. Medical history etc. from family/friends can be very helpful here
  • Ensure oxygen saturations are between 94-98% - this does not have to be achieved by using a rebreather mask
  • If, after a 12-lead ECG, there is evidence of a STEMI, then PPCI is the treatment of choice - even if this means a longer transfer. The PPCI centres will accept post-arrest patients even if they are ventilated (though if your patient is being ventilated, please discuss this with the centre as they have to look at their ITU bed availability - if they are full they may advise nearest A&E)
  • Correct any abnormalities in blood sugar
  • Ensure patency and secure any IV sites
  • Fluids should be given to most patients either running slowly if not hypotensive or quickly if very hypotensive or suspect hypovolaemia.

Got any questions? Remember, you can always access the Clinical Advice Line if you want to talk with someone on scene, or you can email for any general queries about ROSC or cardiac arrest care.

With thanks to Duncan Moore, Area Clinical Lead, for supporting with content for this article.

Want to practice your cardiac arrest management skills? There are still places left for our ‘cardiac arrest bootcamp’ on 30th November at Newmarket training centre. Open to clinicians of all levels, the bootcamp will include interactive lectures, workshops and real-life scenarios. More details available here on Need to Know.

Published 15th November, 2016

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