How to Achieve ROSC in ACLS

ROSC in ACLS. How is it acheived?

What is ROSC in ACLS?

ROSC stands for return of spontaneous circulation. This is the normal heart rhythm that is restored after a cardiac arrest. ROSC is one of the key goals in cardiopulmonary resuscitation (CPR), basic life support (BLS) and advanced cardiopulmonary resuscitation (ACLS).

RELATED: What is the Timing and Duration of Therapeutic Hypothermia in ACLS?

Definition of Return of Spontaneous Circulation (ROSC)

ROSC is achieved following cardiac events when:

  • A pulse and blood pressure return.
  • There is a sudden and sustained increase in ETCO2 greater than or equal to 40 mm Hg.
  • Intra-arterial monitoring reveals spontaneous arterial pressure waves.

Guideline update

Data from the latest American Heart Association (AHA) guidelines show higher likelihood of ROSC when CPR quality is monitored using either ETCO2 or diastolic blood pressure. The monitoring depends on the presence of an endotracheal tube or arterial line, respectively.

RELATED: Accredited ACLS Certification Renewal Online and How it Can Save You Time & Money

Patient about to be discharged from the hospital.

How to Achieve ROSC in an Adult

CPR and defibrillation can be used to restore spontaneous circulation. However, achieving ROSC does not necessarily mean the patient will have a positive long-term prognosis, as some patients have died shortly afterwards. Prompt management of post-cardiac treatments following the return of spontaneous circulation has been demonstrated to lead to improved patient survival and functional recovery.

To detect ROSC during chest compression, arterial pulse palpation and end-tidal CO2 monitoring are used. To be able to accurately assess the pulse palpation, chest compression needs to be temporarily stopped. Furthermore, endotracheal intubation needs to be performed in order for end-tidal CO2 monitoring to take place.

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What are the Signs of ROSC?

Signs of ROSC include the movement of body parts, coughing, and respiration. One can also feel a pulse and measure blood pressure in cases where ROSC is present.

A patient in a hospital receives care following ROSC.

RELATED: Post-Cardiac Arrest Care and How to Achieve the Right PaC02 Levels

What Should an ACLS Provider Do Following ROSC?

Post-cardiac arrest care is essential in order to achieve the best outcomes possible for patients. It is necessary that healthcare institutions should establish a universal, comprehensive and multidisciplinary system of care for treating post-cardiac arrest patients in order to guarantee good results.

This post-cardiac arrest system of care should include:

  • Coronary reperfusion (immediately following ROSC)
  • Targeted temperature management (TTM)
  • Hemodynamic and ventilation optimization
  • Percutaneous coronary intervention for eligible patients (PCI is a minimally invasive procedure to unblock arteries that are narrowed or blocked due to heart conditions)
  • Neurological care and prognostication
  • Other structured interventions

Where Can I Learn ACLS?

There is no better way to learn how to resuscitate a patient by taking an accredited Advanced Cardiac Life Support certification course.

With a Medical ProCerts ACLS certification course, you’ll be prepared to achieve ROSC by learning how to:

  • recognize and provide treatment of a patient during abnormal heart rhythms and cardiac episodes.
  • correctly perform BLS (basic life support).
  • understand ACLS algorithms and protocols.
  • work within effective team dynamics.
  • defibrillate with an AED (automated external defibrillator).
  • know the methods of airway management.
  • understand normal heart anatomy and physiology to quickly identify and treat abnormal deviations.
  • recall drug dosages, access routes and contraindications.
  • provide post-cardiac care.

Sign up for an online, accredited, AHA-compliant ACLS certification course by going to Get certified today!

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