No Return of Pulses in the Field Portends Dismal Survival.


This study’s findings support use of prehospital termination-of-resuscitation protocols.

Prehospital cardiac arrest patients who do not achieve return of spontaneous circulation (ROSC) continue to be transported to the hospital despite the existence of prehospital termination-of-resuscitation protocols (JW Emerg Med Oct 17 2008). To determine survival rates in such patients, researchers analyzed data from two urban emergency medical service systems for patients who experienced cardiac arrest presumed to be of medical etiology from 2008 to 2010.

Among 2483 patients in whom resuscitation was attempted, survival to hospital discharge was 6.6%. ROSC in the field occurred in 36% of patients. Survival rates were 17.2% in patients with ROSC in the field versus 0.7% in those without ROSC. None of the 11 patients who survived without ROSC in the field had an initial rhythm of asystole.

Comment: If termination-of-resuscitation protocols that are based on ROSC had been followed in this study, the transport rate would have been halved. Although the authors’ recommendation for no transport of patients without field ROSC or shockable rhythm would save critical resources and reduce risks to prehospital providers and the public from collisions, nonmedical indications such as family wishes sometimes mandate transport of nonviable patients. When such patients are transported, these data are useful for receiving-hospital emergency physicians to determine whether to continue resuscitative efforts on arrival.

Source: Journal Watch Emergency Medicine

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