Patient management post-ROSC

Side of RRV with lozenge

Cardiac arrests are stressful events for all concerned and if a ROSC is achieved there is cause to celebrate - but in many ways this is only the first step in achieving a 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.

Below are some areas of post-resuscitation care that can optimise survival chances:

  • If ROSC is achieved, do not look to move the patient for at least 10 minutes as this is the period where they are most likely to re–arrest. It is not a race to A&E if ROSC is achieved. Use the time to perform the checks below and plan extrication. Consider rapid removal in traumatic cardiac arrests (TCA).
  • 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 a cardiac arrest we do look at reversible causes, but it is also worth trying during a cardiac arrest to get a working diagnosis that you can work with). 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 (if patients are ventilated, 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.

Duncan Moore, Area Clinical Lead 

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Published 22nd February, 2016

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