Pro/Con from the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine. All of the conference content can be found here: https://scanfoam.org/ssai2017/ Developed in collaboration between scanFOAM, SSAI and SFAI.

1. | 1

2. | 2
Hans Friberg MD, PhD, EDIC
Professor
Center for Cardiac Arrest at Lund University
Lund, Sweden
Should we transport patients in Cardiac
Arrest to hospital or stay on scene?
Pro - Con

3. | 3
Conflict of Interest
• None

4. | 4
Should we transport patients in
Cardiac Arrest to hospital?
• The answer is No!
• The reasons being:
– CPR can be best delivered on scene
– Hospital has little to offer (in most cases)
– May be harmful (patient, ambulance crew, public)
– Costs
– Ethics!

5. | 5Professor Sten Rubertsson, Uppsala University

6. | 6
Should we transport patients in
Cardiac Arrest to hospital or stay on scene?
• In the old days:
– When only hospitals had defibrillators,
the logic was clear – transport...
• Today:
– High quality CPR on scene – by-standers, AEDs,
ambulance crew!
– If ROSC – immediate transport to hospital

7. | 7
Should we transport patients in
Cardiac Arrest to hospital?
• A change has occurred – more patients are
transported to hospital in cardiac arrest!
• Why?
– A misconception that hospitals can do more
– It has become an option – mechanical chest
compression devices

8. | 8
Schneiderman LJ, J Bioeth Inq. 2011
What is the outcome – no pre-hospital ROSC?
398.000 patients (2007-2010)
1-month CPC 1-2: 0.49%
• VF – 3.9 %
• VT – 3.3 %
• PEA – 0,68 %
• Asystoli – 0.15 % Goto et al. Critical Care 2013

9. | 9
2006
2015
1999 -
2002
2003
2004
40 patients
to ED
30 patients
to ED
15 patients
admitted ICU
20 patients
admitted ICU
60 patients
to ED
30 patients
admitted ICU
80 patients
to ED
30-40 patients
admitted ICU
120 patients
to ED
30-40 patients
admitted ICU
*
An example:
OHCA patients
transported to
the ED in Lund
Friberg et al.
unpublished obs

10. | 10
OHCA patients
Lund University Hospital (2010-2015)
No ROSC & transported to hospital –
how often was an intervention performed?
639 patients
402 patients no-ROSC
37 attempted
interventions (9%)
Schmidbauer et al. In manuscript

11. | 11
37 attempted interventions
4 survivors,
the intervention was
considered pivotal in 2!
The 2 survivors would
have been identified
by the TOR rules!
Schmidbauer et al. In manuscript

12. | 12
TOR rules
Verbeek PR et al. Acad Emerg Med 2002
Morrisson LJ et al. Resuscitation 2009
Morrisson LJ et al. Resuscitation 2014
Drennan IR et al. Resuscitation 2017
• No ROSC
• No shocks administered
• Not witnessed by EMS personnel

13. | 13
Ethics
• Qualitative futility
• Quantitative futility
To avoid unnecessary harm and the ethical duty
of proportionality
Schneiderman LJ, J Bioeth Inq. 2011

14. | 14
Schneiderman LJ, J Bioeth Inq. 2011
• Qualitative futility
• Quantitative futility
To avoid unnecessary harm and the ethical duty
of proportionality
Commonly <1%
Ethics
With regard to Out-of-Hospital Cardiac Arrest
• Avoid un-necessary harm
• The right to a dignified death
• The right to a dignified farewell

15. | 15
That said…!

16. | 16
Should we transport patients in
Cardiac Arrest to hospital or stay on scene?
• In a majority of case – NO!
• In rare cases – transport with ongoing CPR
– Accidental hypothermia
– Drug overdose
– Refractory VF
– Within a clinical trial (!)
• And preferably to a hospital with angio/PCI facilities

17. | 17
Thank you!
hans.a.friberg@gmail.com
OK!

18. | 18

19. | 19
Reversible causes
4 H’s
4 T’s
Strong suspicion –
immediate transfer