Recommendations on ambulance cardiopulmonary resuscitation in basic life support systems

Area of Science:

• Emergency Medical Services
• Resuscitation Science
• Prehospital Care

Background:

• Cardiopulmonary resuscitation (CPR) during ambulance transport poses risks to providers and can compromise CPR quality.
• Many Asian countries routinely perform CPR during ambulance transport within basic life support (BLS) systems.
• Standardized best practices for in-ambulance CPR are lacking in BLS environments.

Purpose of the Study:

• To establish evidence-based recommendations for optimizing CPR during ambulance transport in BLS systems.
• To address safety concerns and enhance the quality of resuscitation efforts during prehospital transport.
• To provide guidance for emergency medical services operating in resource-limited settings.

Main Methods:

• A panel of 20 emergency medical services and resuscitation science experts convened for a two-day consensus meeting.
• A literature review identified 33 candidate issues across five core areas related to in-ambulance CPR.
• Delphi methodology, involving two rounds of voting, was employed to achieve expert consensus (>70% agreement).

Main Results:

• Twenty-four consensus statements were established with over 70% expert agreement.
• Recommendations cover critical aspects including scene time, advanced airway procedures, CPR before and during transport, defibrillation, field termination of resuscitation, and transport protocols.
• Specific guidance was provided on staffing, mechanical CPR devices, and feedback mechanisms for CPR quality.

Conclusions:

• A set of recommendations for cardiopulmonary resuscitation during ambulance transport in BLS systems was developed.
• The Delphi methodology facilitated expert consensus on key issues in prehospital resuscitation.
• Further validation of these recommendations in clinical settings is warranted.