Patients who cannot perform any purposeful movements on basic command meet indication for therapeutic hypothermia and targeted temperature management (TTM).
Once you achieve ROSC, your real work starts. Over 60% of patients with ROSC do not survive to hospital discharge. Our job is to optimize treatment and survival.
“I’ve got a pulse,” you hear the nurse shout. Finally, a sigh of relief comes over the crowded resuscitation room and you take a moment to reflect on what just happened… but, your work is just now about to truly begin. It is up to you to determine why the patient died in the first place and determine which crucial steps need to be initiated to increase your patient’s chance of survival.
Based on this evidence, we know the likelihood of ROSC in the field drops significantly after 20-25 minutes. Thus, if the patient receives >3 shocks or >15-20 min of ongoing CPR without recovery of a perfusing rhythm, VA ECMO should be considered.
A team-based approach to the management of the post-ROSC (return of spontaneous circulation) patient focuses on initiation of therapeutic hypothermia, treatment of the underlying cause with transfer to the cath lab where appropriate, and management of the post-cardiac arrest syndrome.
In this systematic review and meta-analysis of the diagnostic test accuracy of the post-ROSC EKG to predict acute coronary lesion or revascularization on coronary angiography in adults after cardiac arrest, ST elevation was found to more specific than sensitive test characteristics and all groups and subgroups.
Although basic life support has been widely practiced to increase recovery from cardiac arrest, management of post-cardiac arrest patients have also made great progress.
Post cardiac arrest syndrome is a complicated compilation of maladaptive physiologic processes experienced after cardiac arrest.
Worldwide survival rates from out-of-hospital cardiac arrest (OHCA) are low, despite great advances in resuscitation science research and technology. For reasons that are complex and multifactorial, many hospitals around the world do not provide systematic, structured post-resuscitation care, thereby contributing to the overall decreased survival rates.
Absent pupillary reflexes and absent motor response to pain are of no prognostic value soon after ROSC (but are of value at 72 hours).
Caring for the post cardiac arrest patient is complex. Efforts to avoid re-arrest and best practices regarding ventilation, oxygenation, and neurocritical care should be provided...
Unfortunately, more than two-thirds of those with ROSC will not leave the hospital alive.
From optimizing tissue oxygen delivery to preventing hyperthermia, an in-depth look at the care of the post-arrest patient.
Targeted Temperature Management (TTM) is currently recommended for all patients regardless of rhythm. The patient should be cooled to 32–36°C as soon as possible after ROSC using whatever technique is available in your institution, and kept cool for 24 hours.
Post-cardiac arrest patients are among the sickest groups of patients seen in the Emergency Department.
The dust has just settled, you’ve achieved Return of Spontaneous Circulation (ROSC) in a cardiac arrest patient – now what? Post cardiac arrest syndrome has the potential for significant morbidity and mortality that persists long after ROSC.