A  The subject of resuscitation is constantly evolving. New therapies such as mechanical CPR devices, percutaneous coronary intervention on patients in arrest, and extracorporeal membrane oxygenation (ECMO) have changed the face of prehospital resuscitation, which no longer has an abysmal survival rate under the right circumstances.

 EMS personnel are expected to provide resuscitative care at the scene. Some resuscitations may take 30 minutes or more. The patient’s BEST CHANCE for resuscitation is at the scene with high quality CPR and code management. Research has shown that CPR quality diminishes while being transported.

A  There are different categories of patients for which considerations of transport should be given:

  •  These patients should be rapidly transported to a cardiac interventional facility if less than a  30 minute transport and defibrillation is the only needed intervention to establish a perfusing rhythm:
    • Patients who have a documented STEMI and EMS witnesses their cardiac arrest after brief resuscitative efforts, including defibrillation as indicated.
    • Patients who have ROSC after VFIB or ROSC with evidence of ST elevation on a transmitted EKG.
  • Patients require prolonged resuscitation efforts if:
    • They have a PEA > 40. The patient may not be in true cardiac arrest, but simply not have palpable pulses due to profound shock.
    • They have an upward trending or persisten EtCO2≥ 20, refractory VF or VT.
  •  Patients needs to be rapidly transported to a Trauma Center if:
    • They arrest due to profound hypothermia.
  • A   Consider aeromedical transport for transports > 30 minutes if the patient has ROSC.
  • A   ♦ Following all appropriate efforts, field termination requires MCP approval, and may only be considered when the following criteria are met:
    • 18 years or older
    • In asystole or PEA rates < 40
    • Not be in arrest due to hypothermia
    • Have an advanced airway in place
    • Have vascular access in place
    • There are no signs of neurological function such as reactive pupils, response to pain or spontaneous movement
  • A   EMS must contact MCP directly to receive consent for field termination and be able to provide the following:
    • The duration of the resuscitation
    • How long the patient may have been in arrest prior to EMS arrival
    • Witnessed or unwitnessed
    • EtCO2
    • Blood glucose
    •  Presenting rhythm.
  • A   ♦ If no ALS equipment is available at the scene, and transport time to a medical facility will exceed 20 minutes, field termination may be considered.
  • A   Send a copy of the run sheet to the EMS Coordinator of the authorizing MCP’s hospital.

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