FACTORS INFLUENCING HOSPITAL TRANSPORT OF PATIENTS IN CONTINUING CARDIAC-ARREST

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.