title: Exploring which patients without return of spontaneous circulation following ventricular fibrillation out-of-hospital cardiac arrest should be transported to hospital?
abstract: BACKGROUND
  Currently many emergency medical services (EMS) that provide advanced cardiac life support (ACLS) at scene do not routinely transport out-of-hospital cardiac arrest (OHCA) patients without sustained return of spontaneous circulation (ROSC). This is due to logistical difficulties and historical poor outcomes. However, new technology for mechanical chest compression has made transport to hospital safer and extracorporeal membrane oxygenation during cardiopulmonary resuscitation (ECPR) enabling further intervention, may result in ROSC. We aimed to explore the characteristics and outcomes of patients with OHCA who were transported to hospital with ongoing CPR in the absence of ROSC, who might benefit from this new technology.
  
  
  RESULTS
  The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for adult OHCA with an initial shockable rhythm between 2003 and 2012. There were 5593 OHCA meeting inclusion criteria. Analysis was performed on 3095 (55%) of patients who did not achieve sustained ROSC in the field. Of these only 589 (20%) had ongoing CPR to hospital. There was a significant decline in rates of transport over the study period. Predictors of transport with ongoing CPR included younger patients, decreased time to first shock and intermittent ROSC prior to transport. Survival to hospital discharge occurred in 52 (9%) of patients who had ongoing CPR to hospital.
  
  
  CONCLUSIONS
  In an EMS that provides ACLS at scene, patients without ROSC in the field who receive CPR to hospital have poor outcomes. Developing a system which provides safe transport with ongoing CPR to a hospital that provides ECPR, should be considered.
authors.affiliation: Alfred Hospital, Australia; Baker IDI Heart and Diabetes Institute, Australia; University of Washington, USA. Electronic address: dionstub@gmail.com.
authors.forename: Dion
authors.initials: D
authors.lastname: Stub
authors.affiliation: Monash University, Australia; Ambulance Victoria, Australia.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Nehme
authors.affiliation: Alfred Hospital, Australia; Monash University, Australia; Ambulance Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.affiliation: Monash University, Australia; Ambulance Victoria, Australia.
authors.forename: Marijana
authors.initials: M
authors.lastname: Lijovic
authors.affiliation: Alfred Hospital, Australia; Baker IDI Heart and Diabetes Institute, Australia; Monash University, Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Kaye
authors.affiliation: Monash University, Australia; Ambulance Victoria, Australia; University of Western Australia, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D022561:Advanced Cardiac Life Support; D000368:Aged; D000369:Aged, 80 and over; D001775:Blood Circulation; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000628:therapy*; D018579:Patient Selection; D012189:Retrospective Studies; D014187:Transportation of Patients; D017211:Treatment Failure; D014693:Ventricular Fibrillation / Q000150:complications; D055815:Young Adult
keywords: Cardiac arrest; Resuscitation; Transport