Prehospital Protocols for Post-Return of Spontaneous Circulation Are Highly Variable.

Area of Science:

• Emergency medicine
• Cardiology
• Prehospital care

Background:

• Up to 44% of out-of-hospital cardiac arrest (OHCA) patients experience rearrest post-return of spontaneous circulation (ROSC), decreasing survival.
• Current cardiac arrest guidelines offer limited direction on prehospital post-ROSC care and transport initiation.
• Prehospital protocols must balance timely hospital care with the risk of early rearrest.

Purpose of the Study:

• To describe current prehospital protocols for post-ROSC care in OHCA patients.
• To identify variations in prehospital treatment and transport strategies following ROSC.

Main Methods:

• Systematic review of a purposeful sample of 75 US prehospital protocols for adult non-traumatic cardiac arrest.
• Protocols were assessed for guidance on post-ROSC care and transport initiation.
• Data abstraction occurred in May 2019, using standardized forms.

Main Results:

• Six protocols (8%) lacked post-ROSC care guidance.
• 12-lead ECG acquisition (84%) and transport to PCI-capable hospitals (73%) were common but not universal.
• Only 12% provided guidance on transport initiation post-ROSC, with 5% mandating a stabilization period.

Conclusions:

• Prehospital post-ROSC care and transport protocols exhibit significant variability across the United States.
• Lack of standardized protocols may affect optimal patient management and outcomes after cardiac arrest.