Return of spontaneous circulation (ROSC) is the resumption of a sustained

heart rhythm ''Heart Rhythm'' is a peer-reviewed medical journal published by Elsevier that covers the study and management of cardiac arrhythmia. It is the official journal of the Heart Rhythm Society, the Cardiac Electrophysiology Society, and thPediatric & ...

that perfuses the body after

cardiac arrest Cardiac arrest (also known as sudden cardiac arrest CA is when the heart suddenly and unexpectedly stops beating. When the heart stops beating, blood cannot properly Circulatory system, circulate around the body and the blood flow to the ...

. 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 Cardiopulmonary resuscitation (CPR) is an emergency procedure used during Cardiac arrest, cardiac or Respiratory arrest, respiratory arrest that involves chest compressions, often combined with artificial ventilation, to preserve brain function ...

has ceased for at least 20 consecutive minutes.

Predictors of ROSC

There are multiple factors during cardiopulmonary resuscitation (CPR) and

defibrillation Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). Defibrillation delivers a dose of electric current (often called a ''count ...

that are associated with success of achieving return of spontaneous circulation. One of the factors in CPR 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 a trend to achieving return of spontaneous circulation with an increased chest compression fraction. 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. A coronary perfusion pressure of 15 mmHg is thought to be the minimum necessary to achieve ROSC. Pertaining to defibrillation, the presence of a shockable rhythm (

ventricular fibrillation Ventricular fibrillation (V-fib or VF) is an abnormal heart rhythm in which the Ventricle (heart), ventricles of the heart Fibrillation, quiver. It is due to disorganized electrical conduction system of the heart, electrical activity. Ventricula ...

or pulseless

ventricular tachycardia Ventricular tachycardia (V-tach or VT) is a cardiovascular disorder in which fast heart rate occurs in the ventricles of the heart. Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple ...

) is associated with increased chances of return of spontaneous circulation. Although a shockable rhythm increases chances for return of spontaneous circulation, a cardiac arrest can present with pulseless electrical activity or

asystole Asystole (New Latin, from Greek privative a "not, without" + ''systolē'' "contraction") is the absence of ventricular contractions in the context of a lethal heart arrhythmia (in contrast to an induced asystole on a cooled patient on a heart-lun ...

, which are non-shockable cardiac rhythms.

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. Patients have died not long after their circulation has returned. One study showed that those who had had an out-of-hospital cardiac arrest and had achieved return of spontaneous circulation, 38% of those people had a cardiac re-arrest before arriving at the hospital with an average time of 3 minutes to re-arrest. Patients with sustained ROSC generally present with post-cardiac arrest syndrome (PCAS). Longer time-to-ROSC is associated with a worse presentation of PCAS. Lazarus phenomenon is the rare spontaneous return of circulation after cardiopulmonary

resuscitation Resuscitation is the process of correcting physiological disorders (such as lack of breathing or heartbeat) in an Acute (medicine), acutely ill patient. It is an important part of intensive care medicine, anesthesiology, trauma surgery and emerg ...

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 following CPR cessation.

References

{{Reflist Cardiology