The odds of surviving out-of-hospital cardiac arrest (OHCA) are significantly better when resuscitation efforts are continued on scene, as opposed to being performed while the patient is being transported to the hospital, a large observational study has found.
The process of moving a patient during resuscitation (known as "scoop and run") may impair or delay best practices, including impairing the quality of cardiopulmonary resuscitation (CPR), say investigators with the Resuscitation Outcomes Consortium (ROC). "Although infrequently there may be individual cases with a specific rationale to pursue hospital transport, overall, these results support a strategy that paramedics dedicate effort and expertise at the scene of the cardiac arrest, rather than prioritizing transport to hospital," first author Brian Grunau, MD, St. Paul's Hospital, Vancouver, British Columbia, Canada, told theheart.org | Medscape Cardiology.
The full cohort included 43,969 patients with a median age of 67 years (interquartile range, 55-80), 37% were women, 86% of cardiac arrests occurred in a private location, 49% were bystander- or EMS-witnessed, 22% had initial shockable rhythms, 97% were treated by out-of-hospital advanced life support, and 26% underwent intra-arrest transport. Survival to hospital discharge was 3.8% for patients who underwent intra-arrest transport and 12.6% for those who received on-scene resuscitation
These results do not support the practice of routinely transporting patients during resuscitation from out-of-hospital cardiac arrest to the hospital.
Grunau B, Kime N, Leroux B, et al. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. JAMA. 2020;324(11):1058–1067. doi:http://dx.doi.org/10.1001/jama.2020.14185