Return of spontaneous circulation

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Return of spontaneous circulation 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 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]

Return of spontaneous circulation can be achieved through cardiopulmonary resuscitation and defibrillation. Return of circulation is not a predictor of a favorable medium- or long-term outcome. 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.[2]

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.[3] 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.[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.[citation needed]

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.[6]

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. ^ 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.
  3. ^ 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.
  4. ^ 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.
  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. ^ 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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