In emergency medical response scenarios, ROSC – the return of spontaneous circulation – refers to the restoration of a palpable pulse and effective circulation following cardiac arrest and cardiopulmonary resuscitation (CPR). With the heart beating on its own again, ROSC is an important medical milestone indicating successful resuscitation efforts.
Achieving ROSC does not guarantee full medical recovery – hospitalization and intensive postresuscitation care are still needed – but is a positive step toward stabilization and survival.
What are key steps to getting ROSC in a cardiac arrest patient?
Timeliness is critical to achieving return of spontaneous circulation and improving survival outcomes. The faster good-quality resuscitation begins, the better the victim’s chances at ROSC and a positive result.
An effective medical response in cardiac arrest scenarios begins with early recognition and quick action. Bystanders should call 911 to summon help and begin CPR immediately. More than 90% of emergency call centers in the U.S. have at least some telephone CPR (T-CPR) training, so call-takers and dispatchers can often provide medical guidance to help inexperienced rescuers work toward return of spontaneous circulation.
Speed matters in obtaining ROSC: With ventricular fibrillation (VF), the most treatable kind of cardiac arrest, survival odds drop by 7%–10% a minute until CPR and other medical interventions begin.
Effective chest compressions (100–120 a minute, with a depth of at least two inches) are essential to keep blood flowing to vital organs and achieving ROSC. Defibrillation within 3–5 minutes of collapse improves the chances of ROSC, as does timely airway management and administration of key Advanced Cardiac Life Support (ACLS) medications like epinephrine and amiodarone.
What are ways to know if ROSC has happened?
Key indicators of return of spontaneous circulation include a detectable pulse (usually checked at a major artery, such as the carotid or femoral); measurable blood pressure; spontaneous breathing; a skin tone that improves from blue-grey to more natural tones; and restoration of an organized heart rhythm on electrocardiogram.
What resuscitation actions come after ROSC?
Once return of spontaneous circulation is achieved, the focus of medical treatment shifts to stabilization, preventing rearrest and minimizing brain injury.
Post-ROSC medical priorities include optimizing hemodynamics to maintain sufficient circulation to vital organs; targeted temperature management for unconscious patients, meaning cooling the body to 32°–36°C for 24–48 hours to reduce oxygen demand and inflammation; oxygenation and ventilation support; and ECG/cardiac monitoring. If a myocardial infarction is suspected, immediate cardiac catheterization is recommended.
Managing arrhythmias and preventing rearrest involves identifying and treating an arrest’s underlying causes. A popular mnemonic for this involves five H’s and five T’s. The H’s stand for common metabolic and physiologic causes of arrest and include:
- Hypoxia
- Hypovolemia
- Hydrogen ions (acidosis)
- Hyper- and hypokalemia
- Hypothermia
The T’s represent common structural and toxic causes and include:
- Tension pneumothorax
- Cardiac tamponade
- Toxins (drug overdose, poisoning)
- Thrombosis of the heart (myocardial infarction)
- Thrombosis of the lungs (pulmonary embolism)
Medications may also help prevent recurrent VF. Other post-ROSC medical measures can include neurological monitoring, infection prevention and managing blood glucose.
