Return of spontaneous circulation

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]

Predictors of ROSC

There are multiple factors during cardiopulmonary resuscitation and defibrillation that are associated with success of achieving return of spontaneous circulation. One of the factors in cardiopulmonary resuscitation 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 an 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 15mmHg 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 suffered from an out-of-hospital cardiac arrest and had achieved return of spontaneous circulation, 38% of those people suffered 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 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.[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. doi:10.1016/j.resuscitation.2014.04.015. 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). doi:10.7759/cureus.12019. 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. 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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