Quick Chart
  • Systematic post-resuscitation care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good neurological function and quality of life.
Clinical Presentation
  • Patients with a return of spontaneous circulation following cardiac arrest.
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • The focus of post resuscitation care is on ensuring adequate cerebral perfusion, oxygenation and supportive treatment to allow the recovery of vital organs.
  • Continue to work as a team.
  • Anticipate re-arrest and plan accordingly.
  • Unless there are compelling reasons to move immediately, DO NOT Rush.
  • ROSC patients are often unstable initially. Time should be taken to plan patient packaging, handling and subsequent egress whilst they stabilise and build up blood pressure. Rough manual handling / jolting of the patient is undesirable. Use this time to ensure IV lines are secure, and acquire 12 Lead ECG’s.
  • Cooling in the prehospital phase is controversial and is a longer term strategy in general. Tympanic temps can be unreliable. The unconscious patient can be blanketed and NO patient should be allowed to shiver.
  • Recovery of infants and children is typically slower than adults as cardiac arrest is usually secondary to prolonged hypoxaemia.
Primary Care
  • Re-evaluate Primary Survey
  • Re-evaluate oxygenation and ventilation
    • Provide supportive ventilation if required
      • Start at age appropriate ventilation rate as necessary; try not to exceed rate indicated as per Clinical Skill
      • Avoid trying to correct abnormally high EtCO2 in the first few minutes.
      • Titrate oxygen delivery as required, aiming for SpO2 between 94 - 98%.
      • Avoid hyperventilation / hyperinflation (as this can impede venous return and stimulate a vagal response, inhibiting the effective rise of mean arterial pressure)
  • Vital Sign Survey
  • Monitor patient persistently, recording full observations every 5 minutes
  • Transport Priority 1, pre-notifying receiving facility
Intermediate Care (EMT / Level 2)
  • As per Primary Care guidelines
Advanced Care (AP)
  • Consider and address precipitating causes of arrest
  • Perform serial 12-lead ECG’s, as reperfusion rhythms may not be of diagnostic quality
  • Manage hypotension if BP is slow to rise:
  • Avoid hypoglycaemia; be aware that blood glucose readings may be inaccurate if peripheries are still poorly perfused. Apply judgement before opting to administer IV glucose.
  • Consider Naloxone
    • Only once circulation is restored
    • Only if there is a strong suspicion that the arrest was caused by opiate/opioid overdose
  • Monitor patient persistently, recording full observations every 5 minutes
  • Transport Priority 1 to appropriate destination, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • N/A

Key Terms & Links
Colour assist:

Document Control

Clinical Services

Responsible Manager
Head of Clinical Services

Published Date

Review Date

St John Ambulance Western Australia Ltd © Copyright 2020, All Rights Reserved

Privacy Policy | Copyright Statement & Disclaimer