Out-of-hospital cardiac arrests initially treated with immediate transport and resuscitation attempts on the way to the hospital (so-called “scoop and run”) seem not to fare as well as those in which emergency personnel stay on-scene to attempt resuscitation until return of spontaneous circulation or termination of resuscitation efforts (“stay and play”).
Researchers examined outcomes from 44,000 adult patients at 10 North American sites. Survival to hospital discharge was 3.8% with immediate transport versus 12.6% with on-scene resuscitative attempts. In a propensity-matched subset of 28,000 patients, survival was 4.0% with immediate transport and 8.5% with on-scene treatment.
Transporting out-of-hospital cardiac arrest (OHCA) patients to the hospital during their arrest instead of completing resuscitation on the spot may hurt their chance of survival, according to new findings published in JAMA.
“Emergency medical services (EMS) personnel follow established guidelines for the treatment of OHCA,” wrote lead author Brian Grunau, MD, MHSc, St. Paul’s Hospital in Vancouver, and colleagues. “If, and when, patients without return of spontaneous circulation (ROSC) are transported to the hospital, however, varies considerably by agency and region. Previous data show wide variability in rates of intra-arrest transport, with some EMS agencies transporting nearly all patients regardless of ROSC, while for others this practice is uncommon if ROSC is not achieved.”
To learn more about how the actions of EMS personnel can impact OHCA outcomes, the study’s authors performed an observational analysis on more than 43,000 patients treated by emergency responders for OHCA from April 2011 to June 2015. All 192 EMS teams included in this research had “the same basic structure” and followed similar protocols based on guidelines from the American Heart Association. The median patient age was 67 years old, 63% of patients were men and 86% of cardiac arrests occurred in a private location. Twenty-six percent of patients underwent intra-arrest transport to a hospital.
Survival to hospital discharge was 3.8% for patients who underwent intra-arrest transport and 12.6% for patients who received on-location resuscitation. Looking at a propensity-matched cohort, survival to hospital discharge was 4% for the intra-arrest transport group and 8.5% for patients the on-location resuscitation group. Also, a “favorable neurological outcome” occurred in 2.9% of patients from the intra-arrest transport group and 7.1% of the on-location resuscitation group.
The team did note that its study had certain limitations, including its observational design and the fact that very few patients were treated with mechanical CPR or “novel invasive resuscitative techniques.” The age of the data is another limitation, the authors added, as it is “uncertain whether these results are fully applicable to out-of-hospital resuscitation and in-hospital post cardiac arrest care in 2020.”
JAMA’s editorialist writes that the results suggest “a strong clinical benefit associated with continuing the resuscitation on scene until a definitive outcome has been achieved.” He notes, however, that randomized trials will be needed to confirm these results.