Post-cardiac-arrest (post-ROSC) care

What it is

Post-cardiac arrest care is where the circular cardiac arrest algorithm hands over, once there is return of spontaneous circulation. Up to that point: activate the emergency response, start CPR, give oxygen, attach the monitor or defibrillator, check the rhythm every 2 minutes, and shock VF/VT.

• Epinephrine IV/IO 1 mg every 3-5 minutes
• For refractory VT/VF, amiodarone IV/IO first dose 300 mg bolus and second dose 150 mg, or lidocaine 1-1.5 mg/kg then 0.5-0.75 mg/kg
• Biphasic shock at the manufacturer recommendation, for example an initial dose of 120-200 J; if unknown, use the maximum available. Second and subsequent doses should be equivalent, and higher doses may be considered.

How it is diagnosed

Return of spontaneous circulation shows as a pulse and blood pressure, as spontaneous arterial pressure waves with intra-arterial monitoring, and as an abrupt sustained increase of PETCO2 of >25 mm Hg, which is the point to check perfusion status. An increase to greater than 40 mm Hg is confirmation of ROSC. The same value shows CPR quality before that point: if PETCO2 is <10 mm Hg, attempt to improve CPR quality. Quality is to push at least 2" deep at 100-120 per minute and allow complete chest recoil; minimize interruptions in compressions; avoid excessive ventilation; rotate the compressor every 2 minutes; and a 30:2 compression-ventilation ratio if there is no advanced airway. With a supraglottic airway or endotracheal intubation, give 10 breaths per minute with continuous chest compressions.