While the best treatment for the constellation of abnormalities associated with the restoration of spontaneous circulation is still evolving, ongoing efforts have identified care strategies to improve outcomes. The 2010 American Heart Association (AHA) Guidelines for CPR and ECC contains a useful post-cardiac arrest care algorithm as well as a table documenting a multi-system approach to care, and clear explanations for current recommendations.12 The guideline states: “A comprehensive, structured, multidisciplinary system of care should be implemented in a consistent manner for the treatment of post-cardiac arrest patients.”12
Survivors of out-of-hospital sudden cardiac arrest should have access to a program that includes structured interventions which have been shown to improve survival, including:
- Therapeutic hypothermia
- Hemodynamic stabilization
- Immediate coronary reperfusion when indicated
- Glycemic control
- Neurologic diagnosis, management and prognostication
EMS systems should learn whether the facility to which they transport their patients has the capability to offer these therapies, and whether or not they are implemented when indicated. If a hospital does not, EMS must act in the patient’s best interest to facilitate transport to a facility that does offer the patient the needed system of care. For example, if the post-cardiac arrest 12-lead ECG shows ST-segment elevation myocardial infarction (STEMI), EMS can request air transport to ensure rapid access to a cardiac catheterization facility.