Those four letters may not seem important to ‘Joe Public’, but they are VERY important to anyone working in emergency medicine.
They stand for Return Of Spontaneous Circulation, and refer to that very rare moment when you restart the heart of someone in cardiac arrest.
I recently achieved my first ever ROSC, and it felt good!
A middle-aged lady had collapsed in a shop and was found to have no pulse or making any effort to breathe – as you may know, either one of these is pretty bad news.
We had arrived within 4 minutes of the 999 call (making the government happy) meaning that her ‘down-time’ without life support in the form of chest compressions and ventilation with a bag valve mask (a rugby ball shaped device used to force oxygen into the lungs) was very short. With every minute that passes without oxygenated blood moving around the body, more and more of the brain dies.
We applied our defibrillator pads and saw that her heart was not beating, but quivering in a rhythm called Ventricular Fibrillation (VF). This is a rhythm that we can shock with 360 Joules of electricity in an attempt to restore a natural rhythm and heartbeat.
We delivered three of these shocks until finally, with a little help from intravenous adrenaline, she got a pulse back. We got ROSC! Despite this, the chances of survival are still very slim – not least of all because we could not find an obvious, correctable, cause of the cardiac arrest.
Within minutes, she was trying to breathe for herself and was even responding to painful stimuli. A Critical Care Doctor was called from our air ambulance (he came by road as the chopper was being used) and sedated her. This might seem counterintuitive but the patient was in a very delicate state, and we needed to be totally in control of her breathing functions. A complex procedure called rapid sequence intubation (RSI) was undertaken and we ‘blued’ the patient to an Emergency Department who we’d phoned ahead to prepare them for our arrival.
Yet again, I will struggle to find out how she is and whether she survived to wake up. But I take comfort knowing that she was ‘alive’ long enough for her family to come and see her – perhaps to say goodbye or to be by her side while she recovered – I’ll never know.