Impact of Transitory ROSC Events on Neurological Outcome in Patients with Out-of-Hospital Cardiac Arrest

Abstract

In out-of-hospital cardiac arrest (OHCA), the occurrence of temporary periods of return to spontaneous circulation (t-ROSC) has been found to be predictive of survival to hospital discharge. The relationship between the duration of t-ROSCs and OHCA outcome has not been explored yet. The aim of this prospective observational study was to analyze the duration of t-ROSCs during OHCA and its impact on outcome. Defibrillator-recorded OHCA events were analyzed via dedicated software. The number of t-ROSC episodes and their overall durations were recorded. The study endpoint was the good neurologic outcome at hospital discharge. Among 285 patients included in the study, 45 (15.8%) had one or more t-ROSCs. The likelihood of t-ROSC occurrence was higher in patients with a shockable rhythm (p = 0.009). The cumulative length of t-ROSC episodes was significantly higher for patients who achieved sustained ROSC (p < 0.001). The adjusted cumulative t-ROSC length was an independent predictor for good neurological outcome at hospital discharge (OR 1.588, 95% CI 1.017 to 2.481; p = 0.042). According to our findings and data from previous studies, t-ROSC episodes during OHCA should be considered as a favorable prognostic factor, encouraging continuing resuscitative efforts.

Successful Coil Embolization Using Percutaneous Cardiopulmonary Support in a Patient with Refractory Out-of-hospital Cardiac Arrest Caused by Aneurysmal Subarachnoid Hemorrhage

“…Nevertheless, repeated ROSC episodes with higher-quality CPR might be considered for ECPR even after prolonged periods of CPR. 27) The occurrence of any ROSC event during CPR, even if short or unstable, can ensure a markedly higher tissue perfusion pressure than that in chest compressions. 27) The pathophysiological mechanisms of SAH-induced TCM have not been clearly elucidated.…”

“…27) The occurrence of any ROSC event during CPR, even if short or unstable, can ensure a markedly higher tissue perfusion pressure than that in chest compressions. 27) The pathophysiological mechanisms of SAH-induced TCM have not been clearly elucidated. 16,28) The most widely accepted mechanism is an excessive release of catecholamines, leading to transient left ventricular dysfunction without the evidence of obstructive coronary artery disease.…”

“… 27) The occurrence of any ROSC event during CPR, even if short or unstable, can ensure a markedly higher tissue perfusion pressure than that in chest compressions. 27) …”

Association between duration of return of spontaneous circulation and outcomes after out-of-hospital cardiac arrest

“…Return of spontaneous circulation (ROSC) is a core outcome element of cardiopulmonary resuscitation (CPR) both in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest and has been considered a standard in the evaluation of successful resuscitation. [1][2][3] However, the definition or criterion of ROSC is disputed and varies in different guidelines and studies. [4][5][6] The 2015 American Heart Association (AHA) Guidelines for cardiac arrest and CPR outcome define ROSC as a clinical assessment that shows signs of life comprising a palpable pulse or generating a blood pressure.…”

Association Between Duration of Return of Spontaneous Circulation and Favorable Outcomes After Out-of-Hospital Cardiac Arrest

“…Return of spontaneous circulation (ROSC) is a core outcome element of cardiopulmonary resuscitation (CPR) both in out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), and has been considered a standard in the evaluation of successful resuscitation [1][2][3]. However, the de nition or criterion of ROSC is disputed, and varies in different guidelines and studies [4][5][6].…”