Pre-hospital ROSC in cardiac arrest: how important is it?

Paramedics make difficult decisions every day, but few carry more consequences for the patient than the decision whether to transport people who are in cardiac arrest, or to stay on scene continuing the resuscitation attempt. The colloquial phrases ‘stay and play’ and/or ‘load and go’ are often heard in ambulance station crew rooms referring to these decisions.

UK Resuscitation Council (2010) pre-hospital guidelines state that ‘following out-of-hospital cardiac arrest, failure of ALS-trained emergency medical services (EMS) personnel to achieve return of spontaneous circulation (ROSC) at the scene is associated with an extremely low probability of survival’, with rare exceptions occurring in hypothermic and overdosed patients. The above statement is reflected in this quantitative study from Wampler et al, which aims to examine the influence of pre-hospital ROSC on cardiac arrest survival to discharge rates.

The researchers performed a retrospective analysis of data relating to attempted cardiac arrest resuscitations (2008–2010) from two cities in the United States. In fact, the data was being collected prospectively although not primarily for this study: the San Antonio Fire Department was collecting data for their quality assurance/improvement programme and the Cincinnati Fire Department was participating in another study examining out-of-hospital cardiac arrests.