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. 2024 Jun 21:19:100691.
doi: 10.1016/j.resplu.2024.100691. eCollection 2024 Sep.

Pre-hospital care after return of spontaneous circulation: Are we achieving our targets?

I A Vos  1 , F G Lucassen  1   2 , B W J Bens  1 , B Dercksen  3   4   5 , R Postma  3   6 , E M F Jorna  7 , J C Ter Maaten  1   8 , M M R F Struys  3 , E Ter Avest  1   9
Affiliations

Pre-hospital care after return of spontaneous circulation: Are we achieving our targets?

I A Vos et al. Resusc Plus. .

Abstract

Background: Early restoration of normal physiology when return of spontaneous circulation (ROSC) is obtained after an out-of-hospital cardiac arrest (OHCA) reduces the risk of developing post-cardiac arrest syndrome (PCAS). This study aims to investigate if (and to which extent) this can be achieved within the scope of practice of standard emergency medical services (EMS) crews.

Methods: A prospective mixed-methods quantitative and qualitative cohort study was performed including adult patients with a non-traumatic OHCA presented to a university hospital emergency department (ED) in the Netherlands after pre-hospital ROSC was obtained. Primary endpoint was the percentage of patients with deranged physiology post-ROSC in whom EMS crews were able to reach recommended treatment targets.

Results: During a 32-month period, 160 patients presenting with ROSC after OHCA were included. Median (IQR) pre-hospital treatment duration was 40 (34-51) minutes. When deranged physiology was present (n = 133), it could be restored by EMS crews in 29% of the patients. Although average etCO2 and SpO2 improved gradually over time during pre-hospital treatment, recommended treatment targets could not be achieved in respectively 55% (30/55) and 43% (20/46) of the patients. Similarly, airway problems (24/46, 52%), hypotension (20/23, 87%) and post-anoxic agitation (16/43, 37%) could often not be resolved by EMS crews. The ability to restore normal physiology by EMS could not be predicted based on patient characteristics or in-arrest variables.

Conclusion: Deranged physiology after an OHCA is commonly encountered, and often difficult to treat within the scope of practice of regular EMS crews. Involvement of advanced critical care teams with a wider scope of practice at an early stage may contribute to a better outcome for these patients.

Keywords: Post-resuscitation care; emergency medical services (EMS); out-of-hospital cardiac arrest (OHCA).

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Consort diagram. Legend figure 1. OHCA, out-of-hospital cardiac arrest; UMCG, University Medical Centre Groningen; ED, emergency department; ROSC, return of spontaneous circulation.
Fig. 2
Fig. 2
Change in SpO2 over time after ROSC. Legend figure 2. Mean (95% CI) peripheral oxygen saturation (SpO2) after return of spontaneous circulation (ROSC).
Fig. 3
Fig. 3
Change in etCO2 over time after ROSC. Legend figure 3: Mean (95% CI) end-tidal carbon dioxide (etCO2) prior to- and after return of spontaneous circulation (ROSC).
Supplementary Fig. 1
Supplementary Fig. 1
study area. Legend supplementary file 1: graphic visualisation of the study area in the northern part of the Netherlands. The study centre is depicted in red. Other PCI centres are depicted in blue, whilst non-cardiac centres are depicted in grey.
See this image and copyright information in PMC

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