If we pick up a patient and the patient presents with a positive 12-lead STEMI and you are travelling to the PCI Center and the patient codes, do we run the full 20 minute cardiac arrest protocol, or could you consider STEMI as a reversible cause (Hs and Ts) , analyze once and head to the closest receiving which may not be the PCI due to distance.

A confirmed STEMI would be considered a reversible cause and should be considered for early transport to hospital (as long as the underlying rhythm is not refractory VF/VT) regardless of whether the arrest occurs on scene or en-route.

Please note that the direction for a patient who arrests en-route has recently changed. Please see the updated direction (here) sent to SWORBHP paramedics June 22, 2023. The advised practice for a patient who suffers a witnessed arrest en-route to the hospital is to find a safe place to stop the ambulance and:

• • Perform minimum one analysis.

• • Utilize clinical judgement (utilizing multiple factors) to decide whether to stay and perform resuscitation:

• • Perform one analysis and go (likely the majority of situations where rhythm is non-shockable)

• • Perform three full analyses and go (ex. Persistent shockable rhythm)

• • Perform three full analyses and patch for direction if it is believed the patient would benefit from ongoing resuscitation in a stationary ambulance (this would be a rare occurrence).

Cardiac/Circulation,Medical Cardiac Arrest

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