Predictors of ROSC in witnessed aeromedical cardiac arrests

Aeromedical agencies are used routinely to transport critically ill patients to specialty centers. The characteristics of patients suffering a cardiac arrest during transport by aeromedical flight personnel are not well-documented. We completed a retrospective analysis of aeromedical patient care records in order to describe the pre-arrest characteristics and the return of spontaneous circulation (ROSC) in this subset of patients.

A retrospective chart reviews of patients suffering from cardiac arrest while being treated by a single aeromedical transport service between 1998 and 2000. Crew configurations were paramedic/nurse or paramedic/physician. Data were directly abstracted by the authors and descriptive data of patient demographics, vital signs and medical history were obtained. Data were separated into medical and traumatic arrests and analyzed by chi2- and t-test. Logistic regression analyses were performed to determine predictors of ROSC.

During the 24-month interval, 12,140 patient transports occurred. Of these, 134 cardiac arrests occurred (1.1%) and are reviewed. Of these, 57 were medical arrests and 76 were traumatic arrests. Nine medical arrests and 37 traumatic arrests were excluded as the patient was in cardiac arrest before crew arrival. In the medical arrest cohort, the presence of a peripheral i.v. before crew arrival and initial rhythm of arrest were associated with ROSC at destination (p=0.05). In the traumatic arrest cohort, patients with lower diastolic blood pressures had a trend toward lower rates of ROSC (p=0.06).

Cardiac arrest during aeromedical transport is infrequent. Patients with poor i.v. access are less likely to experience ROSC should they experience a cardiac arrest. Patients with traumatic injury and diastolic hypotension may be less likely to survive cardiac arrest during transport.