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Subject: ROSC vs ROPR
Author: Michael Bjarkoy
Posted: Fri 11th Jan 2008
Hi all

I think everyone has it wrong...
Scenario - cardiac arrest. CPR, defib and other bits and bobs gets a pulse back on the patient = ROSC. But is a return of a carotid pulse either good enough to suggest ti is good enough to perfuse major organs (brain etc) and therfore stimulate respiratory drive - I think not.

Here's the thing.
In the AED algorhtyhm the rescuers continue CPR until the patient begins to breathe. The rationale is that people who use AEDs are generally unable (40% or the time) to identify a pulse when one exists. However a spin off from this is that policy makers have identified (by allowing this practice) that performing CPR on a patient with a pulse is relatively safe. We see it on infants with a pulse of less than 60 that CPR is safe and my experience confirms this with adults.

In our professional current practice, once we identify a ROSC (of a carotid pulse) we stop chest compressions and concentrate on ventilatory support. Hmm. I think this is an outdated concept as to assume a carotid pulse represents a perfusing rhtyhm which is good enough to trigger respiratory effort is doubtful (I believe).

Recent evidence suggests that a BP OF 90mmHg is too low to perfuse major organs and a recent paper concludes that we should be looking at a BP of 115mmHg.

Therefore once we get a pulse back on the patient, I believe we should continue to perform chest compressions even if we get both carotid and radial pulses back until the patient begins to breathe as this probably represents an output significant enough to be classified as a Return Of Perfusing Rhtyhm (ROPR).

You heard it here first - either I have totally lost it or I am suggesting the next change in our cardiac arrest treatment.

Mike Bjarkoy.

ref for paper (trauma) is...
Topic Title: Hypotension Begins at 110 mm Hg: Redefining "Hypotension" With Data
Topic Summary: J Trauma 2007; 63:291-299.

Background: Clinicians routinely refer to hypotension as a systolic blood pressure (SBP)

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