Question: This question is to clarify a point in the FBAO cardiac arrest protocol. If the airway obstruction is resolved after a first analysis, it is stated that the patient can then be treated per the medical cardiac arrest directive (presumably receiving three more analyses for a total of four). My question is regarding what to do if transport is in progress when the obstruction is removed- is transport continued with CPR only (as it is not a new arrest or a re-arrest after ROSC) or can the vehicle be stopped until the protocol is complete?
This is a terrific question. Thanks for submitting it. The answer is not addressed by the directive. If in the event you are in the transport phase with a patient in cardiac arrest related to a FBAO, and during transport (after having completed your scene protocol) the obstruction is resolved, we suggest that you do not pull over but rather continue on with transport to the hospital.
We acknowledge that the directive does state: "If the patient is in cardiac arrest following the removal of the obstruction, initiate management as a medical cardiac arrest" however we feel that this should not be applied when en-route to the hospital.
Our rationale for this is that most hypoxia related cardiac arrests (such as foreign body airway obstructions) result in agonal cardiac arrest rhythms such as asystole and PEA, and pulling over the ambulance to allow for further analyses with the defibrillator is unlikely to be of benefit.