Study objective: Prior research has established the futility of contin
ued resuscitation efforts for patients in cardiac arrest who fail to r
espond to out-of-hospital advanced cardiac life support. Determination
of both medical and nonmedical factors resulting in the transport of
patients in continuing cardiac arrest to the hospital may encourage th
e development of new systems or strategies to increase the appropriate
ness of these transports. Methods: The attending paramedic completed a
prospective survey after unsuccessful resuscitation efforts in our ur
ban, hospital-based, two-tier emergency medical services (EMS) system.
All nontraumatic adult arrests were included unless they were clearly
noncardiac in nature. Results: Paramedics responded to 259 cardiac ar
rests between September 12, 1996, and April 31, 1997. Seventy-nine pat
ients were pronounced dead without resuscitation efforts. Of the remai
ning 180 patients, 44 had return of spontaneous circulation and were t
ransported to the hospital, 68 were pronounced dead in the field, and
68 were transported to the hospital in continuing cardiac arrest. The
68 patients transported while in cardiac arrest are the focus of this
study. Rare problems with field termination were identified. Reasons f
or transport of the 68 patients in continuing cardiac arrest included
arrest in ambulance or going to ambulance (n=6), arrest in a public pl
ace (n=17), environmental factors (n=6), road hazard to paramedics (n=
l), possible reversible cause (n=4), persistent ventricular dysrhythmi
a (n=5), no intravenous access (n=5), airway difficulties (n=5), famil
y unable to accept field termination (n=3), cultural or language barri
er (n=l), EMS physician ordered transport (n=l), and obesity (n=l). A
protocol allowing pronouncement of death in the ambulance and transpor
t of the body to a designated area could have prevented lights-and-sir
en transport to the emergency department in 24 of the 68 cases. Conclu
sion: Factors other than medical ones often influence the decision to
transport patients in continuing cardiac arrest. In our urban system,
physician, medical examiner, and paramedic education and protocols wer
e needed to aid decisionmaking in this situation.