Resuscitation Plus (Jun 2024)

Ongoing CPR with an onboard physician

  • Alfredo Echarri Sucunza,
  • Patricia Fernández del Valle,
  • Jose Antonio Iglesias Vázquez,
  • Youcef Azeli,
  • Jose María Navalpotro Pascual,
  • Juan Valenciano Rodriguez,
  • Cristian Fernández Barreras,
  • Sonia Royo Embid,
  • Carmen Gutiérrez-García,
  • María Isabel Ceniceros Rozalén,
  • Cesar Manuel Guerra García,
  • Carmen del Pozo Pérez,
  • María José Luque-Hernández,
  • Silvia Sola Muñoz,
  • Ana Belén Forner Canos,
  • María Isabel Herrera Maíllo,
  • Marcos Juanes García,
  • Natividad Ramos García,
  • Belén Muñoz Isabel,
  • Junior Jose García Mendoza,
  • José Antonio Cortés Ramas,
  • Faustino Redondo Revilla,
  • Inmaculada Mateo-Rodríguez,
  • Félix Rivera Sanz,
  • Emily Knox,
  • Antonio Daponte Codina,
  • José Ignacio Ruiz Azpiazu,
  • Fernando Rosell Ortiz

Journal volume & issue
Vol. 18
p. 100635

Abstract

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Introduction: Recent data are not available on ongoing CPR for emergency services with an onboard physician. The aim of the present study was to identify factors associated with the decision to transport patients to hospital with ongoing CPR and examine their survival to hospital discharge with good neurological status. Methods: An observational study based on a registry of out-of-hospital cardiac arrests attended to by emergency services with an onboard physician. All OHCA cases occurring between the 1st of January and the 31st of December 2022 were included. Patients receiving ongoing CPR during transport to the hospital were compared with patients pronounced dead at the scene following arrival of the care team. The dependent variable was ongoing CPR during transport to the hospital. The main characteristics and the neurological status of patients surviving to discharge were described. Results: A total of 9321 cases were included, of which 350 (3.7%) were transported to hospital with ongoing CPR. Such patients were young (59.9 ± 20.1 years vs 64.6 ± 16.9 years; p < 0.001; 95%CI: 0.98 [0.98; 0.99]) with arrest taking place outside of the home (151 [44.5%] vs 4045 [68.01%]; p < 0.001; 95%CI: 0.41 [0.31; 0.54]) and being witnessed by EMS (126 [36.0%] vs 667 [11.0%]; p < 0.001; 95%CI: 4.31 [3.19; 5.80]), whilst initial rhythm differed from asystole (164 [47.6%] vs 4325 [73.0%]; p < 0.01; 95%CI: 0.44 [0.33; 0.60]) and a mechanical device was more often employed during resuscitation and transport to hospital (199 [56.9%] vs 2050 [33.8%]; p < 0.001; 95%CI: 2.75 [2.10; 3.59]). Seven patients (2%) were discharged alive from hospital, five with ad integrum neurological recovery (CPC1) and two with minimally impaired neurological function (CPC2). Conclusions: The strategy of ongoing CPR is uncommon in EMS with an onboard physician. Despite their limited efficacy, the availability of mechanical chest compression devices, together with the possibility of specific hospital treatments, mainly ICP and ECMO, opens up the possibility of this approach with determined patients.

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