The new Medical Cardiac Arrest Directive requires 20 minutes of resuscitation on scene. Point # 5 of the Primary Clinical Consideration(s) states ...or other known reversible cause of arrest not addressed. My question has to do with refractory PEA and the amount of potential reversible causes (7 Hs 5 Ts). Would it be reasonable to patch for request of early transport in the presence of 3 consecutive analysis of PEA?
You may always patch to the BHP to discuss optimal management in any patient care, including in the situation you describe.
Please note however that not all PEA arrests are created equally. A non-agonal PEA (ex. heart rate 60 and ETC02 30mmHg aligning with potential circulatory perfusion) has a much better prognosis than a PEA with a heart rate of <10 and low ETC02. Multiple factors come into play when deciding optimal scene resuscitation time including (but not limited to): transport time to hospital, patient age and underlying comorbidities, ability to perform high quality chest compressions and resuscitative care during extrication and transport etc.
Please note that assessing reversible causes is much more involved than analyzing the underlying rhythm. Many factors including historical information, patient assessment and bystander information help determine if this is a potential reversible cause of arrest and may bring to light a reason to depart scene after the first analysis, per the Primary Considerations.