Post-ROSC care:
Okay, so you have initiated resuscitation and defibrillation, and your patient has regained a palpable pulse. Awesome, now what? In truth we place a lot of emphasis on running a code, but not very much on what to do if we actually manage to get a ROSC.
As anyone who has actually managed to reach this point will tell you, a return of spontaneous circulation is still a very unstable situation (especially if we are dealing with ACLS and cardiac epinephrine is involved). I am a primary care paramedic, so I will be keeping this discussion related to BLS post-ROSC care. ALS providers have the ability to do a few more things in this situation, depending on the patient's presentation, however a number of details crossover between the BLS and ALS scope of practice, particularly in Canada.
First things first:
We need to repeat our primary assessment at this point. This means we have to ensure our airway and ventilations are adequate with good lung compliance. We also want to look at our ETCO2 and SPO2. Ideal ranges to target are an ETCO2 of 30-40mmHg, and an SPO2 of 94-98%. Next we need to focus on circulation and supporting the heart that we have just massaged back into a perfusing rhythm. This means we need to establish IV access, and consider a fluid bolus to target an SBP of at least 90mmHg. Finally we need a full set of vitals before we move.
Lets move:
If we have the luxury of an automated CPR device, we need to get the patient on it if we haven't already. The autopulse, which is what I use, serves as an extrication device, so once we have freed up everyone from CPR we can work to move the patient to the stretcher.
12-Lead:
Ideally we want to get a 12-lead ECG within 10 minutes of a ROSC. This provides us with significant information about the patient's cardiac status and will be very important for the ED Doctor. Depending upon where you work, you may be able to bypass a CTAS 1 STEMI (That would be highest priority for those outside of Canada).
What if the patient re-arrests:
Well, this is actually what usually tends to happen. In this case, we want to stop the ambulance and perform a single analysis/defibrillation, and then carry on to the ED. If you got a ROSC once, you may be able to get another, but the patient needs diesel therapy at this point.
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