Ongoing CPR with an onboard physician

• Published in: Resuscitation plus Vol. 18; p. 100635
• Main Authors: Sucunza, Alfredo Echarri, Fernández del Valle, Patricia, Vázquez, Jose Antonio Iglesias, Azeli, Youcef, Navalpotro Pascual, Jose María, Rodriguez, Juan Valenciano, Barreras, Cristian Fernández, Embid, Sonia Royo, Gutiérrez-García, Carmen, Rozalén, María Isabel Ceniceros, García, Cesar Manuel Guerra, del Pozo Pérez, Carmen, Luque-Hernández, María José, Muñoz, Silvia Sola, Canos, Ana Belén Forner, Maíllo, María Isabel Herrera, García, Marcos Juanes, García, Natividad Ramos, Isabel, Belén Muñoz, Mendoza, Junior Jose García, Ramas, José Antonio Cortés, Revilla, Faustino Redondo, Mateo-Rodríguez, Inmaculada, Sanz, Félix Rivera, Knox, Emily, Codina, Antonio Daponte, Azpiazu, José Ignacio Ruiz, Ortiz, Fernando Rosell
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-06-2024; Elsevier
• Subjects: Emergency medical services; Ongoing CPR; Out of hospital cardiac arrest; Survival; Ongoing CPR; Survival; Out of hospital cardiac arrest; Emergency medical services
• ISSN: 2666-5204; 2666-5204
• DOI: 10.1016/j.resplu.2024.100635

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.
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.
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).
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.