Transportation during and after cardiac arrest: who, when, how and where?

Abstract

Purpose of reviewOut-of-hospital cardiac arrest (OHCA) is the most devastating and time-critical medical emergency. Survival after OHCA requires an integrated system of care, of which transport by emergency medical services is an integral component. The transport system serves to commence and ensure uninterrupted high-quality resuscitation in suitable patients who would benefit, terminate resuscitation in those that do not, provide critical interventions, as well as convey patients to the next appropriate venue of care. We review recent evidence surrounding contemporary issues in the transport of OHCA, relating to who, where, when and how to transport these patients. Recent findingsWe examine the clinical and systems-related evidence behind issues including: contemporary approaches to field termination of resuscitation in patients in whom continued resuscitation and transport to hospital would be medically futile, OHCA patients and organ donation, on-scene versus intra-transport resuscitation, significance of response time, intra-transport interventions (mechanical chest compression, targeted temperature management, ECMO-facilitated cardiopulmonary resuscitation), OHCA in high-rise locations and cardiac arrest centers. We highlight gaps in current knowledge and areas of active research.

Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease

“…Despite all efforts already undertaken, more research is required to investigate why the immediate survival advantage does not translate into longer term survival. This may eventually result in improved measures in the prehospital24 25 or in-hospital26 phase to increase overall survival chances.…”

Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

“…Despite advances in therapeutics such as targeted temperature management (TTM), mechanical circulatory support, and neuroprognostication, urgent questions remain pertaining to how best to organize hospitals and emergency care systems to improve access to quality care and clinical outcomes. 8 …”

“…This understanding also aids the rational ambulance diversion strategy to bring the right patients to the right destinations. 8 , 25 …”

Variation in community and ambulance care processes for out-of-hospital cardiac arrest during the COVID-19 pandemic: a systematic review and meta-analysis

“…However, the unprecedented coronavirus disease 2019 (COVID-19) pandemic had a poorly understood impact on EMS resources and was believed to have disrupted the prehospital “chain of survival” particularly layperson or bystander response 3 , 4 . There is tremendous scientific and public health interest in how community and EMS-related processes were altered since these confer larger survival impact relative to advanced hospital-based interventions, and the benefits of the latter are confined to those who had received timely prehospital interventions 5 . Understanding the impact of the COVID-19 pandemic on OHCA care processes is key to planning of future public health programs and policies to improve OHCA outcomes in the post-pandemic era and pandemic-preparedness.…”