Question: If our patient goes vsa while on route to Cath lab via bypass approval, and we obtain a ROSC, do we continue to Cath lab or divert to closest ED?

Please refer to the BLS PCS STEMI Bypass Protocol.  It depends on the condition of the patient post ROSC, and per direction from the interventional cardiology program.

Pertinent contraindications under the STEMI Bypass protocol to consider in the described situation are:

1. CTAS 1 and the paramedic is unable to secure patients airway or ventilate. In these situations, the protocol states that patients should be transported to the closest ED

2. In cases where the patient is experiencing a complication requiring PCP or ACP diversion as described as:
3. Moderate to severe respiratory distress or use of CPAP (PCP) €“or- Ventilation inadequate despite assistance (ACP)
4. Hemodynamic instability or symptomatic SBP <90mmHg at any point (PCP) €“or- Hemodynamic instability unresponsive/not amenable to ACP treatment/management (ACP).

CACC and the cardiac interventionalist should be made aware of the patients condition change and details of the arrest/patient condition post ROSC. You may be directed to the closest ED, or to continue on to the cath lab, depending on the particular situation.

Please note that the interventionalist may not be able to answer their phone if they are en route to hospital.  If such a situation arises and you are unable to contact the interventionalist, paramedic decision making, taking into account the patient condition and transport times should be employed  Following this, when the clinical situation allows, please re-attempt to update the interventionalist.

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ROSC

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