Dion Stub1, Ziad Nehme2, Stephen Bernard3, Marijana Lijovic2, David M Kaye4, Karen Smith5. 1. Alfred Hospital, Australia; Baker IDI Heart and Diabetes Institute, Australia; University of Washington, USA. Electronic address: dionstub@gmail.com. 2. Monash University, Australia; Ambulance Victoria, Australia. 3. Alfred Hospital, Australia; Monash University, Australia; Ambulance Victoria, Australia. 4. Alfred Hospital, Australia; Baker IDI Heart and Diabetes Institute, Australia; Monash University, Australia. 5. Monash University, Australia; Ambulance Victoria, Australia; University of Western Australia, Australia.
Abstract
BACKGROUND: Currently many emergency medical services (EMS) that provide advanced cardiac life support (ACLS) at scene do not routinely transport out-of-hospital cardiac arrest (OHCA) patients without sustained return of spontaneous circulation (ROSC). This is due to logistical difficulties and historical poor outcomes. However, new technology for mechanical chest compression has made transport to hospital safer and extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) enabling further intervention, may result in ROSC. We aimed to explore the characteristics and outcomes of patients with OHCA who were transported to hospital with ongoing CPR in the absence of ROSC, who might benefit from this new technology. METHODS AND RESULTS: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for adult OHCA with an initial shockable rhythm between 2003 and 2012. There were 5593 OHCA meeting inclusion criteria. Analysis was performed on 3095 (55%) of patients who did not achieve sustained ROSC in the field. Of these only 589 (20%) had ongoing CPR to hospital. There was a significant decline in rates of transport over the study period. Predictors of transport with ongoing CPR included younger patients, decreased time to first shock and intermittent ROSC prior to transport. Survival to hospital discharge occurred in 52 (9%) of patients who had ongoing CPR to hospital. CONCLUSION: In an EMS that provides ACLS at scene, patients without ROSC in the field who receive CPR to hospital have poor outcomes. Developing a system which provides safe transport with ongoing CPR to a hospital that provides ECPR, should be considered.
BACKGROUND: Currently many emergency medical services (EMS) that provide advanced cardiac life support (ACLS) at scene do not routinely transport out-of-hospital cardiac arrest (OHCA) patients without sustained return of spontaneous circulation (ROSC). This is due to logistical difficulties and historical poor outcomes. However, new technology for mechanical chest compression has made transport to hospital safer and extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) enabling further intervention, may result in ROSC. We aimed to explore the characteristics and outcomes of patients with OHCA who were transported to hospital with ongoing CPR in the absence of ROSC, who might benefit from this new technology. METHODS AND RESULTS: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for adult OHCA with an initial shockable rhythm between 2003 and 2012. There were 5593 OHCA meeting inclusion criteria. Analysis was performed on 3095 (55%) of patients who did not achieve sustained ROSC in the field. Of these only 589 (20%) had ongoing CPR to hospital. There was a significant decline in rates of transport over the study period. Predictors of transport with ongoing CPR included younger patients, decreased time to first shock and intermittent ROSC prior to transport. Survival to hospital discharge occurred in 52 (9%) of patients who had ongoing CPR to hospital. CONCLUSION: In an EMS that provides ACLS at scene, patients without ROSC in the field who receive CPR to hospital have poor outcomes. Developing a system which provides safe transport with ongoing CPR to a hospital that provides ECPR, should be considered.
Authors: Emilie Gregers; Jesper Kjærgaard; Freddy Lippert; Jakob H Thomsen; Lars Køber; Michael Wanscher; Christian Hassager; Helle Søholm Journal: Crit Care Date: 2018-09-29 Impact factor: 9.097
Authors: Shir Lynn Lim; Karen Smith; Kylie Dyson; Siew Pang Chan; Arul Earnest; Resmi Nair; Stephen Bernard; Benjamin Sieu-Hon Leong; Shalini Arulanandam; Yih Yng Ng; Marcus Eng Hock Ong Journal: J Am Heart Assoc Date: 2020-10-23 Impact factor: 5.501