Medic SBK Looks at Cardiac Arrest Care
One of the measurements that many EMS systems use to determine if they are “doing it right” is their survival rate for cardiac arrest patients. These numbers are broken down in many different ways but the accepted “standard” seems to be witnessed arrest with a shockable rhythm (ventricular fibrillation or ventricular tachycardia). In other words, the patients with the best possible chance at survival.
One of my current tasks in my system is entering all of our data into the CARES registry so that our patients can be matched with their hospital outcome and our system performance can be tracked for cardiac arrests. Typical of most quality improvement projects, part of this one involves figuring out how to do what we do better.
Over at MedicSBK, there’s a post entitled “Doing it Better” that looks at precisely this idea. In this post, Scott contrasts his system with that of Wake County in North Carolina. I have been lucky enough to hear Brett Myers speak about cardiac arrest care and the approach that his system takes is revolutionary and it works. By performing CPR only on scene and packaging a patient for transport only after sustained return of circulation, they are locking their crews into focusing on high quality chest compressions. This, along with defibrillation, is the only treatment that has been PROVEN to help cardiac arrest victims. I say good for them!
I recently began analyzing the quality of compressions that our crews perform in conjunction with our first response agencies. A quick Twitter poll leads me to believe that many EMS systems are not performing detailed analysis of this important component of care. Our findings have mirrored Dr. Myers views on when and where to treat these patients: despite the best efforts of everyone involved, CPR quality suffers during transport and lengthy pauses in CPR are not uncommon. The conclusion? We should not be transporting under CPR! Treat these patient where they drop.
I’m lucky in that my crews have the latitude to remain on scene during resuscitation. We transport very few of our cardiac arrest patients and usually only after regaining pulses. Thanks to Scott for bringing this up about his system. I hope that we can all move towards treatment algorithms that closely mimic Wake County and that allow us to provide optimal care in the optimal setting.
What about your system? Do you routinely transport during CPR? Do you wait for a certain length of ROSC before transporting? Let me know in the comments.