Return of Spontaneous Circulation (ROSC)

Indications: Patient has a return of circulation after resuscitation was initiated.

0.9% Fluid Bolus: If hypotensive (systolic BP < 90mmHg) and chest auscultation is clear infuse 10ml/kg to a maximum volume of 1000ml. Reassess every 100mls for patients < 12 years of age and every 250mls for patients ≥ 12 years of age.

Therapeutic Hypothermia: Males ≥ 18 years and females ≥ 50 years and have a systolic BP ≥ 90 mmHg or greater. Contra-indications: Traumatic Cardiac Arrest (penetrating and blunt), Suspected cause of arrest to be sepsis or serious infection, Hypothermic Arrest, Known coagulopathy (medical history or medication).

Following any ROSC consider optimizing ventilations and oxygenation by titrating the patient’s oxygenation to at least 94%. Avoid hyperventilation and target an ETCO2 of 35 to 40 mmHg with a continuous waveform.

Dopamine: If patient is hypotensive and does not have an allergy or sensitivity to dopamine, is not in a tachydysrhythmia or a mechanical shock state, is not hypovolemic and does not suffer from pheochromocytoma infuse Dopamine at an initial rate of 5mcg/kg/min IV.

 

Dopamine Infusion Chart

Dopamine (mg/kg/min)25101520
40kg37.51522.530
50kg3.759.5192830.75
60kg4.511.522.534.545
70kg5.251326.539.552.5
80kg615304560
90kg6.75173450.567.5
100kg7.51937.556.575
110kg8.2520.541.56282.5
Note: for solutions of 800mcg/ml ("single strength") the infusion rate from the chart should be multiplied by 2 (e.g. twice the above infusion rate).