Which of the following confirms return of spontaneous circulation (ROSC)?

The presence of a pulse is the definitive indicator of return of spontaneous circulation (ROSC). When a patient exhibits a palpable pulse after experiencing a cardiac arrest, it signifies that the heart has resumed effective pumping actions, allowing for blood flow to the body's organs. This restoration of circulation is crucial, as it marks a significant turning point in patient management during resuscitation efforts.

While improvements in level of consciousness, stable blood pressure, and decreased respiratory effort may indicate positive developments in a patient's condition, they are secondary signs. For instance, an improved level of consciousness might occur after ROSC, indicating that the brain is receiving sufficient blood flow, but it alone cannot confirm ROSC. Similarly, stable blood pressure is an important factor in assessing overall cardiovascular stability, but it may not occur immediately or may not be present initially once ROSC is achieved. Decreased respiratory effort might suggest that the patient is either recovering or entering respiratory failure, but again, it does not provide direct confirmation of heart function restoration. Thus, the palpable presence of a pulse remains the most direct evidence of ROSC during the resuscitation process.