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Cardiac Arrest... When to Transport.
First, Transporting a patient in cardiac arrest is NOT beneficial unless the receiving facility is prepared and equipped to continue the resuscitation by treating reversible causes that EMS cannot. This is for EMS and ED providers.
A 42 year old man awoke in the middle of the night with sudden, sharp chest pain and shortness of breath. He had no previous cardiac history and appeared very fit. His wife called 911. EMS arrived to find their patient in severe extremis and poorly perfused. He progressed to PEA arrest and the crew performed high quality CPR immediately. Advanced airway Obtained IV access. Several rounds of epinephrine. They worked the code for 20 minutes per protocol but did not get ROSC in the field so they called it.
The patient had minor surgery within the last week...
The hospital was half a mile away...
Take Home Points:
- Most patients who suffer an OHCA will not survive intact unless ROSC occurs in the field.
- There are reversible causes that most EMS systems cannot treat but an Emergency Department can.
- There will be a small subset of viable patients that may be saved if transported expeditiously.
- It is possible to transport patients in cardiac arrest safely with manual CPR and, perhaps someday, mechanical chest compressions and ventilation will open up additional options for longer transports to tertiary hospitals.
- We must give every patient a chance for a successful outcome if such a chance exists. That is what Resuscitationist do! We must not give up unless there is nothing else that can be done.
SMACC/Cliff Reid - When Should Resuscitation Stop
ED ECMO - Annie (May 2013), 60+ minutes of CPR
Dr. Smith's ECG Blog - 68 minutes with chest compressions, full recovery.
Continuous mechanical chest compression during in-hospital cardiopulmonary resuscitation of patients with pulseless electrical activity
Double Bolus Thrombolysis for Suspected Massive Pulmonary Embolism during Cardiac Arrest
A simplified and structured teaching tool for the evaluation and management of pulseless electrical activity.