Prehospital Emergency Care, Vol. 16, No. 4, Pages 451-455
Despite accepted termination-of-resuscitation criteria existing, many patients are transported to hospitals without achieving field return of spontaneous circulation (ROSC) which opens the suggestion to whether emergency medical services (EMS) should convey patients without ROSC.
The researchers examined field ROSC influence on OHCA survival to hospital discharge in two large urban EMS systems – San Antonio Fire Department and Cincinnati Fire Department. A retrospective analysis of prospectively collected data was conducted for all attempted resuscitations of medical OHCA and cardiac OHCA for San Antonio and Cincinnati, respectively, from 2008 to 2010. A total of 2,483 resuscitation attempts were evaluated and while age and gender distributions were similar between cities, ethnic profiles differed. Cincinnati had 17% more patients with an initial shockable rhythm and was more likely to initiate transport before field ROSC. Overall survival to hospital discharge was 165 of 2,483 (6.6%). More than one-third (894 of 2,483, 36%) achieved field ROSC. Survival with field ROSC was 17.2% (154 of 894) and without field ROSC was 0.69% (11 of 1,589). Of the 11 survivors transported prior to field ROSC, nine received defibrillation by EMS. No asystolic patient survived to hospital discharge without field ROSC and the researchers concluded that survival to hospital discharge after OHCA is rare without field ROSC.
The article suggests that resuscitation efforts should focus on achieving field ROSC and transport should be reserved for patients with field ROSC or a shockable rhythm, however, the authors recognise that both of the datasets fail to include some or part of important time intervals, including response time, time spent on scene, and time from dispatch to hospital arrival and that response times may be a reason for the differing rates of VF/VT rhythms. While this article provides evidence to termination of resuscitation procedures, it is also suggests that compliance with such a procedure should not be mandatory but that transportation decision should always be made on the whole clinical picture.
http://informahealthcare.com/doi/abs/10.3109/10903127.2012.695435