Abstract 254: Should All Patients without Sustained Return of Spontaneous Circulation Following Ventricular Fibrillation Out-of Hospital Cardiac Arrest be Transported to Hospital?
Background: Many worldwide emergency medical services, including Ambulance Victoria, do not routinely transport patients without sustained return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrests (OHCA), given the logistical difficulties and historical poor outcomes. The significant recent advancements in resuscitation techniques for prolonged cardiac arrest including mechanical chest compression and extracorporeal membrane oxygenation assisted CPR makes the decision of when and where to cease resuscitative efforts increasingly difficult. We aimed to explore the characteristics and outcomes of patients with OHCA who do not achieve sustained ROSC using the Victorian Ambulance Cardiac Arrest Registry (VACAR).
Methods and Results: The VACAR was searched for adult non-EMS witnessed OHCAs with an initial shockable rhythm between 2003 and 2012. There were 5654 OHCA meeting inclusion criteria. Analysis was performed on 3095 (54%) of patients who did not achieve sustained ROSC in the field. Of these patients only 589 (20%) had ongoing CPR to hospital with the remainder declared deceased. Patients transported with ongoing CPR were younger (median 63 vs 68 years, p<0.01), had shorter response times and time to first defibrillation, but longer resuscitation times (median 42 vs 33 minutes, p <0.01). Survival to hospital discharge occurred in 52 (9%) of patients with ongoing CPR during transportation to hospital. 97% of these patients were discharged with a favourable neurological outcome. Independent predictors of a patient being transported to hospital with ongoing CPR included younger patients, who arrested in public places, and received longer resuscitation times.
Conclusion: Patients receiving ongoing CPR during transport to hospital have better outcomes than previously reported. Declaring patients deceased in the field in the setting of an initial shockable rhythm, in which ROSC cannot be achieved may no longer be warranted. The further development of systems of care that incorporate transport of patients requiring ongoing CPR is urgently needed.
- © 2013 by American Heart Association, Inc.