Under clinical considerations medical cardiac arrest, plan for extrication and transport after 3 analyses. For Pediatric arrest would we do 3 analyses and go or complete 3 on scene and 4th before departing in ambulance?
Please see the Ask MAC post from March 30, 2022 (see below) that discusses considerations for when to depart scene with a pediatric VSA patient.
To answer your specific question: If you opt to stay on scene for 3 analyses, you are not required to perform a 4th before departing. Once the third analysis has been completed, priority then becomes expedient transport to hospital. If timing of extrication works out so that it is time for a 4th analysis when you are preparing to depart, you would be supported in following your resuscitation algorithm, completing an analyses every 2 minutes.
March 30, 2022 Question:
Good day, forgive me if Im mis-reading this, but CPER digest Oct 2021 just published an info-graphic suggestive of staying on scene to run a complete 4 analyses in the case of a pediatric cardiac arrest with a suspected cause/history which is highly suggestive of hypoxia/respiratory in origin. The rationale that theyre presenting is that youve got an arrest where CPR and artificial respirations are our best bet for reversing the cause of the arrest. Any discussion related to this? I believe that our current SWORBHP directives are to depart after 1 analysis for a suspected reversible cause of arrest, (unless the rhythm is shockable). Thanks for any clarification that you can provide.
March 30, 2022 Answer:
The recommendations surrounding pediatric cardiac arrest management in the prehospital setting (early transport versus scene treatment) continues to evolve. Recently, there is some preliminary evidence to suggest that the earlier epinephrine is administered the higher the likelihood of survival. Optimal evidence-based care continues to evolve and the OBHG MAC continues to review evidence and how it relates to all directives within the ALS PCS.
The ALS PCS Cardiac Arrest Medical Directive allows for some clinical judgement when it comes to managing pediatric cardiac arrests. SWORBHP Medical council recommends scene management when it comes to rhythms that are amendable to defibrillation. In cases where defibrillation is not required (hypoxia, sepsis, etc.), paramedics can consider early transport.
This direction allows more paramedic flexibility in assessing each situation. We understand that there are many factors that impact the decision to transport or stay-and-play. Location of call (2 minutes from hospital versus ½ hour), underlying suspected cause of arrest, scope and experience of responders (PCP vs ACP etc). Documentation of your decision-making process is valuable so we can better understand and support your thinking and care when we review these calls.