Return of spontaneous circulation

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Return of spontaneous circulation (ROSC) is the resumption of a sustained heart rhythm that perfuses the body after cardiac arrest. It is commonly associated with significant respiratory effort. Signs of return of spontaneous circulation include breathing, coughing, or movement and a palpable pulse or a measurable blood pressure. Someone is considered to have sustained return of spontaneous circulation when circulation persists and cardiopulmonary resuscitation has ceased for at least 20 consecutive minutes. [1]

Contents

Predictors of ROSC

There are multiple factors during cardiopulmonary resuscitation (CPR) and defibrillation that are associated with success of achieving return of spontaneous circulation. One of the factors in CPR is the chest compression fraction, which is a measure of how much time during cardiac arrest are chest compressions performed. A study measured the effects of chest compression fraction on return of spontaneous circulation in out-of-hospital cardiac arrest patients with a non-ventricular fibrillation arrhythmia and it showed a trend to achieving return of spontaneous circulation with an increased chest compression fraction. [2] Another study highlighted the benefits of minimizing chest compression intervals before and after shocking a patient's rhythm, which would in turn increase chest compression fraction. [3] A coronary perfusion pressure of 15 mmHg is thought to be the minimum necessary to achieve ROSC. [4]

Pertaining to defibrillation, the presence of a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia) is associated with increased chances of return of spontaneous circulation. [5] Although a shockable rhythm increases chances for return of spontaneous circulation, a cardiac arrest can present with pulseless electrical activity or asystole, which are non-shockable cardiac rhythms. [6]

Prognosis

Return of spontaneous circulation can be achieved through cardiopulmonary resuscitation and defibrillation. Though ROSC is necessary for survival, it is not, itself, a predictor of a favorable medium- or long-term outcome. [7] Patients have died not long after their circulation has returned. One study showed that those who had had an out-of-hospital cardiac arrest and had achieved return of spontaneous circulation, 38% of those people had a cardiac re-arrest before arriving at the hospital with an average time of 3 minutes to re-arrest. [8] Patients with sustained ROSC generally present with post-cardiac arrest syndrome (PCAS). Longer time-to-ROSC is associated with a worse presentation of PCAS. [9]

Lazarus phenomenon is the rare spontaneous return of circulation after cardiopulmonary resuscitation attempts have stopped in someone with cardiac arrest. This phenomenon most frequently occurs within 10 minutes of cessation of resuscitation, thus passive monitoring is recommended for 10 minutes following CPR cessation. [10]

References

  1. ↑ Jacobs I, Nadkarni V, Bahr J, et al. (November 2004). "Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports". Circulation. 110 (21): 3385–97. doi: 10.1161/01.CIR.0000147236.85306.15 . PMID   15557386.
  2. ↑ Vaillancourt, Christian; Everson-Stewart, Siobhan; Christenson, Jim; Andrusiek, Douglas; Powell, Judy; Nichol, Graham; Cheskes, Sheldon; Aufderheide, Tom P.; Berg, Robert; Stiell, Ian G. (December 2011). "The Impact of Increased Chest Compression Fraction on Return of Spontaneous Circulation for Out-of-Hospital Cardiac Arrest Patients not in Ventricular Fibrillation". Resuscitation. 82 (12): 1501–1507. doi:10.1016/j.resuscitation.2011.07.011. ISSN   0300-9572. PMC   3215827 . PMID   21763252.
  3. ↑ Sell, Rebecca E.; Sarno, Renee; Lawrence, Brenna; Castillo, Edward M.; Fisher, Roger; Brainard, Criss; Dunford, James V.; Davis, Daniel P. (July 2010). "Minimizing pre- and post-defibrillation pauses increases the likelihood of return of spontaneous circulation (ROSC)". Resuscitation. 81 (7): 822–825. doi:10.1016/j.resuscitation.2010.03.013. ISSN   1873-1570. PMID   20398991.
  4. ↑ Sutton, Robert M.; Friess, Stuart H.; Maltese, Matthew R.; Naim, Maryam Y.; Bratinov, George; Weiland, Theodore R.; Garuccio, Mia; Bhalala, Utpal; Nadkarni, Vinay M.; Becker, Lance B.; Berg, Robert A. (August 2014). "Hemodynamic–directed cardiopulmonary resuscitation during in–hospital cardiac arrest". Resuscitation. 85 (8): 983–986. doi:10.1016/j.resuscitation.2014.04.015. PMC   4087068 . PMID   24783998.
  5. ↑ Czapla, Michał; Zielińska, Marzena; Kubica-Cielińska, Anna; Diakowska, Dorota; Quinn, Tom; Karniej, Piotr (2020-06-12). "Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study". BMC Cardiovascular Disorders. 20 (1): 288. doi: 10.1186/s12872-020-01571-5 . ISSN   1471-2261. PMC   7291476 . PMID   32532201.
  6. ↑ Grunau, Brian; Reynolds, Joshua C.; Scheuermeyer, Frank X.; Stenstrom, Robert; Pennington, Sarah; Cheung, Chris; Li, Jennifer; Habibi, Mona; Ramanathan, Krishnan; Barbic, David; Christenson, Jim (April 2016). "Comparing the prognosis of those with initial shockable and non-shockable rhythms with increasing durations of CPR: Informing minimum durations of resuscitation". Resuscitation. 101: 50–56. doi:10.1016/j.resuscitation.2016.01.021. ISSN   1873-1570. PMID   26851705.
  7. ↑ Shin, Heejun; Kim, Giwoon; Lee, Younghwan; Moon, Hyungjun; Choi, Hanjoo; Lee, Choung Ah; Choi, Hyuk Joong; Park, Yongjin; Lee, Kyoungmi; Jeong, Wonjung (December 2020). "Can We Predict Good Survival Outcomes by Classifying Initial and Re-Arrest Rhythm Change Patterns in Out-of-Hospital Cardiac Arrest Settings?". Cureus. 12 (12): e12019. doi: 10.7759/cureus.12019 . PMC   7793532 . PMID   33437558.
  8. ↑ Salcido, David D.; Stephenson, Amanda M.; Condle, Joseph P.; Callaway, Clifton W.; Menegazzi, James J. (2010). "Incidence of Re-arrest after Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest". Prehospital Emergency Care. 14 (4): 413–418. doi:10.3109/10903127.2010.497902. ISSN   1090-3127. PMC   3226713 . PMID   20809686.
  9. ↑ Komatsu, Tomohide; Kinoshita, Kosaku; Sakurai, Atsushi; Moriya, Takashi; Yamaguchi, Junko; Sugita, Atsunori; Kogawa, Rikimaru; Tanjoh, Katsuhisa (2014-07-01). "Shorter time until return of spontaneous circulation is the only independent factor for a good neurological outcome in patients with postcardiac arrest syndrome". Emergency Medicine Journal. 31 (7): 549–555. doi:10.1136/emermed-2013-202457. ISSN   1472-0205. PMC   4078719 . PMID   23639589.
  10. ↑ Adhiyaman, Vedamurthy; Adhiyaman, Sonja; Sundaram, Radha (December 2007). "The Lazarus phenomenon". Journal of the Royal Society of Medicine. 100 (12): 552–557. doi:10.1177/0141076807100012013. ISSN   0141-0768. PMC   2121643 . PMID   18065707.
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