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  1. ROSC and Post Cardiac Arrest Care

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Show full transcript for ROSC and Post Cardiac Arrest Care video

Every healthcare system should implement a comprehensive and multidisciplinary system of care in a universal and consistent manner for the treatment of post cardiac arrest patients in order to ensure the best outcomes.

In this lesson, we'll cover the goals after the return of spontaneous circulation (also known as ROSC), including the two phases of treatment post resuscitation to help ensure the patient's future survival and long-term care.

When a pediatric patient has a return of spontaneous circulation after cardiac arrest, there are two important phases of care that should follow:

  1. First phase: The continuation of advanced life support.
  2. Second phase: To focus on neurologic and core temperature management to protect the patient's core components as they recover from such a traumatic event.

The First Phase of ROSC

During this phase, you'll continue to provide advanced life support for any immediate life-threatening conditions and focus on the ABC's – airway, breathing, and circulation.

Because respiratory complications and hemodynamic instability are primary early causes of mortality after ROSC, it's vital to provide optimal oxygenation and ventilation.

One of the goals during phase one is keep an SpO2 of greater than 94 percent. Certain diagnostic tools should be utilized to optimize care such as:

  • Monitor end-tidal CO2 with capnography
  • Assess arterial blood gas
  • Obtain a chest X-ray to confirm proper endotracheal tube position in the mid trachea

In addition, perfusion needs to be stabilized and cardiopulmonary function needs to be monitored.

Another goal during phase one is to treat any persistent shock. This may require fluid boluses of 20ml/kg or medications such as epinephrine and/or dopamine. Adequate blood pressure also must be maintained, and any arrhythmias need to be properly treated.

And lastly, any reversible or contributing causes of the cardiac arrest, such as the H's and the T's, need to be identified and treated.

The Second Phase of ROSC

The main goal during the second phase of care after the return of spontaneous circulation, is to maintain and provide neurologic care for the patient, along with targeted temperature management.

An adequate blood glucose level and adequate sedation, along with the appropriate analgesia, need to be maintained during the second phase of ROSC.

In the first few hours following a successful resuscitation, the appropriate fluid maintenance needs to be administered depending on the child's hemodynamic condition.

Pro Tip #1: It's important to note that the common cause of morbidity in the latter stages following a return of spontaneous circulation typically result from multi-organ failure or serious brain injury, or a combination of both. It's equally important to understand that children who experience a return of spontaneous circulation after cardiac arrest, might also experience a complex combination of pathophysiological processes including:

  • Brain injury
  • Myocardial dysfunction
  • Systemic ischemia
  • Organ system dysfunction
  • Persistent conditions, such as those that may have led to the cardiac arrest in the first place.

In order to stabilize the patient and provide the best outcome for them, the treatment of these complicated and multisystem pathologies will most likely require a consultation with a pediatric specialist and other expert healthcare providers and team members.

The key to successful and long-term care following a return of spontaneous circulation includes the following:

  • Stabilize the pediatric patient
  • Provide continuous and close monitoring of the patient
  • Frequently assess the patient for any changes in their condition

And finally, the advanced life support provider will also want to transfer the patient to the appropriate and effective definitive next level of care and do so as soon as possible.