Rational: Out of hospital cardiac arrest is a devastating event with a high mortality. Survival rates have increased over the last years, with the availability of AED's and public BLS. Previous studies have shown that deranged physiology after return of spontaneous circulation (ROSC) is associated with a worse neurological outcome. Good quality post-arrest care is therefore of utmost importance. Objective: To determine how often prehospital crews (with their given skills set) encounter problems meeting optimal post-ROSC targets in patients suffering from OHCA, and to investigate if this can be predicted based on patient-, provider- or treatment factors. Study design: Prospective cohort study of all patients attended by the EMS services with an OHCA who regain ROSC and are transported to a single university hospital, in order to identify those patients with a ROSC after a non-traumatic OHCA who had deranged physiology and/or complications from OHCA EMS personnel was unable to prevent/deal with in the prehospital environment. Study population: Patients, \>18 years, transported by the EMS services to the ED of the University Hospital Groningen (UMCG) with a ROSC after OHCA in a 1 year period Main study parameters/endpoints: Primary endpoint of our study is the percentage of OHCA patients with a prehospital ROSC who arrive in hospital with either a deranged physiology or with complications from OHCA EMS personnel was unable to deal with.
Study Type
OBSERVATIONAL
Enrollment
175
percentage of OHCA patients with a prehospital ROSC who arrive in hospital with either a deranged physiology or with complications from OHCA EMS personnel was unable to deal with
Any of the below 5 minutes or more after ROSC is obtained: * -Airway intervention (SGA or ETT) not performed (when deemed necessary) * Actively Vomiting in absence of ETT after ROSC B: -Hypoxia: -SaO2 \<94% on at least two consecutive readings * Hypercarbia: -ETCO2\>5.5 kPa on at least two consecutive readings\*\* C: -Low cardiac output: -Re-arrest during transport to hospital * ETCO2\<3.0 on two consecutive readings * MAP\<65mmHg on two consecutive readings * SBP\<100 mmHg on two consecutive readings upon arrival in ED D: -Hypoxic agitation upon arrival in ED or uncontrolled prehospital hypoxic agitation despite benzodiazepine administration or when benzodiazepines contraindicated) * Seizures during transport E: -Hyperthermia
Time frame: From pre-hospital ROSC to arrival at ED, approximately 1-2 hours
Duration of period with deranged physiology, measured from moment of first occurrence until resolved or until arrival in hospital.
Any of the following measured in minutes: * -Airway intervention (SGA or ETT) not performed (when deemed necessary) * Actively Vomiting in absence of ETT after ROSC B: -Hypoxia: -SaO2 \<94% on at least two consecutive readings * Hypercarbia: -ETCO2\>5.5 kPa on at least two consecutive readings\*\* C: -Low cardiac output: -Re-arrest during transport to hospital * ETCO2\<3.0 on two consecutive readings * MAP\<65mmHg on two consecutive readings * SBP\<100 mmHg on two consecutive readings upon arrival in ED D: -Hypoxic agitation upon arrival in ED or uncontrolled prehospital hypoxic agitation despite benzodiazepine administration or when benzodiazepines contraindicated) * Seizures during transport E: -Hyperthermia
Time frame: From pre-hospital ROSC to arrival at ED, approximately 1-2 hours
Patient- and resuscitation factors related to deranged physiology and/or complications in the post arrest phase
Time frame: From pre-hospital ROSC to arrival at ED, approximately 1-2 hours
Opinion of EMS providers weather or not they felt they were able to provide optimal post arrest care
Measured by a survey, filled out by EMS crew at arrival at ED
Time frame: From pre-hospital ROSC to arrival at emergency department, approximately 1-2 hours
Comparison of primary outcome of secondary outcomes between post ROSC patients attended by EMS only vs EMS and HEMS
Time frame: From pre-hospital ROSC to arrival at emergency department, approximately 1-2 hours
Frequency distribution of airway interventions (SGA or ETT) not performed (when deemed necessary)
-Airway intervention (SGA or ETT) not performed (when deemed necessary) in ED. NB NOT change of SGA for ETT when SGA is functioning well
Time frame: From pre-hospital ROSC to arrival at emergency department, approximately 1-2 hours
Frequency distribution of actively vomiting in absence of ETT after ROSC in prehospital setting
Time frame: From pre-hospital ROSC to arrival at ED, approximately 1 to 2 hours
Frequency distribution of the presence of hypoxia
SaO2 \<94% on at least two consecutive readings
Time frame: From pre-hospital ROSC to arrival at ED, approximately 1 to 2 hours
Frequency distribution of low cardiac output
Presence of one of the following: * Re-arrest during transport to hospital * ETCO2\<3.0 on two consecutive readings * MAP\<65mmHg on two consecutive readings 12 * SBP\<100 mmHg on two consecutive readings
Time frame: From pre-hospital ROSC to ICU (or CCU) admission, up to about 1 hours
Frequency distribution of hypoxic agitation upon arrival in ED or uncontrolled prehospital hypoxic agitation despite benzodiazepine administration or when benzodiazepines contraindicated)
Assessed by physician who enrolls patient
Time frame: From pre-hospital ROSC to arrival at ED, approximately 1-2 hours
Frequency distribution of seizures during transport
Time frame: From pre-hospital ROSC to arrival at ED, approximately 1-2 hours
Frequency distribution of the presence of hyperthermia
Defined as a temperature \>37.5 celsius
Time frame: From pre-hospital ROSC to arrival at ED, approximately 1-2 hours
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.