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Differential diagnosis and cause-specific treatment during out-of-hospital cardiac arrest: a retrospective

Elina Heikkilä1, Milla Jousi1, Jouni Nurmi2

  • 1Department of Emergency Medicine and Services, University of Helsinki and University Hospital, Helsinki, Finland.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
|April 11, 2023
PubMed

Insights

Helicopter emergency medical services frequently used ultrasound and blood tests during out-of-hospital cardiac arrest (OHCA) resuscitation. However, cause-specific treatments were administered less often, suggesting a need to improve diagnostic protocols for more effective interventions.

Area of Science:

  • Emergency Medicine
  • Critical Care
  • Cardiology

Background:

  • Cardiopulmonary resuscitation (CPR) guidelines emphasize treating reversible causes of out-of-hospital cardiac arrest (OHCA).
  • The frequency of identifying and treating these causes during emergency medical services (EMS) care remains unclear.

Purpose of the Study:

  • To estimate the utilization of point-of-care ultrasound and blood sample analyses during OHCA.
  • To determine the frequency of cause-specific treatments administered during OHCA by EMS.

Main Methods:

  • Retrospective study of 549 non-traumatic OHCA patients treated by a physician-staffed helicopter emergency medical service (HEMS) from 2016-2019.
  • Data collected on the use of ultrasound, blood analyses, and specific therapies beyond standard CPR interventions.

Main Results:

  • Ultrasound was employed in 60% of cases, and blood analyses in 24%.
  • Cause-specific treatments were given to 15% of patients, including extracorporeal CPR, percutaneous coronary intervention, thrombolysis, and fluid resuscitation.

Conclusions:

  • HEMS physicians utilized diagnostic tools like ultrasound and blood tests in 84% of OHCA cases.
  • The study highlights frequent use of diagnostic methods but relatively infrequent application of cause-specific treatments, indicating a need for protocol evaluation.
Abstract

Keywords:
Air ambulancesCritical careEmergency medical serviceHelicopter emergency medical serviceOut-of-hospital cardiac arrest

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