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One year experience with fast track algorithm in patients with refractory out-of-hospital cardiac arrest

Christoph Adler1, Christian Paul2, Guido Michels3

  • 1Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Cologne, Germany; Department of Emergency Medicine, Fire Department City of Cologne, Cologne, Germany.

Resuscitation
|August 12, 2019
PubMed

Insights

A novel fast track algorithm (FTA) for refractory out-of-hospital cardiac arrest (OHCA) patients significantly improved neurological outcomes. This rapid transport approach with ongoing cardiopulmonary resuscitation (CPR) shows promise for better survival in selected OHCA cases.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Critical Care

Background:

  • Prognosis for out-of-hospital cardiac arrest (OHCA) is poor, particularly when return of spontaneous circulation (ROSC) is not achieved pre-hospital.
  • The benefit of rapid hospital transport with ongoing cardiopulmonary resuscitation (CPR) for refractory OHCA (rOHCA) is not well-established.

Purpose of the Study:

  • To evaluate the effectiveness of a novel fast track algorithm (FTA) in improving outcomes for patients with rOHCA.

Main Methods:

  • A prospective single-center study compared outcomes in rOHCA patients treated with FTA against historical controls.
  • rOHCA was defined by persistent shockable rhythm after 3 shocks/300mg amiodarone or persistent non-shockable rhythm with 10 min CPR without ROSC.

Main Results:

  • The FTA group had significantly shorter pre-hospital times (69±18 vs. 79±24 min, p=0.02).
  • Favorable neurological outcome (CPC score 1 or 2) was significantly more frequent in the FTA group (27.5% vs. 11.4%, p=0.038).
  • A trend towards improved survival was observed with FTA implementation (70.0% vs. 82.9% mortality, p=0.151).

Conclusions:

  • A rapid transport algorithm with ongoing CPR is feasible for selected rOHCA patients.
  • The FTA approach significantly improves neurological outcomes and may enhance survival rates in refractory OHCA cases.
Abstract

Keywords:
Extracorporeal cardiopulmonary resuscitationNeurological outcomeOngoing CPROut-of-hospital cardiac arrestRefractory cardiac arrest

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