return of spontaneous circulation (ROSC) post-arrest

see also:

• choking / respiratory arrest / cardiac arrest / BLS / ALS / CPR
• cardiac arrhythmias
• bradycardia
• the shocked hypotensive patient

• this applies to patients who have been revived from choking / respiratory arrest / cardiac arrest / BLS / ALS / CPR or ventricular fibrillation (VF) and have attained return of spontaneous circulation (ROSC)
• an important early consideration is understanding the patient's likely prognosis, pre-morbid condition and advanced care directives
• these patients often have impaired cognitive function and if they have not already been intubated, may required intubation and ventilatory support
• these patients often have persistent poor cardiac function and cardiogenic shock requiring inotropic support to maintain adequate circulation, and these patients will probably benefit from having an arterial line inserted and perhaps a central venous line
  • patients who are unable to maintain an adequate circulation despite inotropic support and a search for reversible factors, are likely to have further resuscitation attempts futile and thus should be considered for withdrawal of active resuscitation and for palliation
• some patients who have had a acute myocardial infarction (AMI/STEMI/NSTEMI) may be candidates for transfer to cath lab for emergent angioplasty
• patients who have had long down times and likely brain death but who are able to maintain a circulation are usually best admitted to ICU where discussions can be had with family around organ donation and withdrawal of resuscitative care - discussions of organ donation generally should NOT be held in the ED
  • see post-coma unresponsiveness (persistent vegetative state)