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ROSC Post-Cardiac Arrest Care Algorithm

This algorithm shows the steps for rescuers to take when treating a post-cardiac arrest patient who has resumed a normal heart rhythm with a perceptible pulse. Please enjoy our interactive algorithm. CLICK ON ANY BOUNCING OBJECTS AND LISTEN AS YOU FOLLOW ALONG, or simply click on the expand icon in the top right corner to see the whole algorithm.

ROSC Post-Cardiac Arrest Care Algorithm

  1. Return of spontaneous circulation (ROSC). Immediate management of post-cardiac care after the return of spontaneous circulation can improve survival rates and functional recovery in the patient.
  2. Optimize ventilation and oxygenation. Starting with 10 breaths a minute, use the lowest inspired oxygen concentration necessary to maintain SATs of 94% or greater. Use continuous waveform capnography to confirm and monitor the correct placement of the ET tube if needed. Avoid hyperventilation.
  3. Treat Hypotension (SBP <90 mm Hg). Treat hypotension when systolic blood pressure is less than 90. First obtain IV access if it’s not already established, and verify the patency of the IV lines. Then treat the hypotension with IV bolus and vasopressor infusion. Consider treating any reversible causes that may have precipitated the cardiac arrest.
  4. 12-Lead ECG: STEMI. Obtain a 12-lead ECG as soon as possible after the return of spontaneous circulation to identify patients with STEMI or a high suspicion of acute myocardial infarction(AMI).
  5. Coronary reperfusion. If STEMI is detected, EMS personnel should transport the patient to an appropriate facility quickly to reduce time to treatment. Hospital personnel should begin coronary reperfusion with percutaneous coronary intervention (PCI).
  6. Follow Commands? If STEMI or AMI are not detected, determine the patient’s ability to follow commands.
  7. Initiate targeted temperature management (TTM). If the patient is unable to follow commands or respond in a meaningful way, the high-performance team should initiate TTM.
  8. Advanced critical care. Once TTM has been initiated, or if the patient is responsive and able to follow commands, the patient should be transferred to advanced critical care.