If I’m doing a STEMI bypass and patient goes VSA, do I transport to nearest ED or continue to go to PCI centre? And could you explain as well If I obtain a ROSC during said transfer, closest ED or continue to PCI centre?

According to the BLS PCS STEMI Hospital Bypass Protocol paragraphs 2 (d) and (e), a contraindication to STEMI bypass is VSA without return of ROSC.  However, the Protocol also states, “Notwithstanding paragraphs 2 (c), (d), (e) above, attempt to determine if the interventional cardiology program at the PCI centre will still permit the transport to the PCI centre. Essentially it is saying the cardiac interventionalist should be made aware of the patient’s condition change. 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.  

Regarding ROSC: Please see the Ask MAC from Mar 4 2021 and April 27, 2021 where this question was asked previously. link 

Please see the following Ask MAC from Sept 13, 2023 regarding best practices for a patient who arrests en route after a positive 12-lead ECG (and correlating clinical condition affording the decision to pursue STEMI Bypass).  link 

Cardiac Ischemia,Cardiac/Circulation,Medical Cardiac Arrest

Arrest En-Route, Bypass, Cardiac Arrest, Cath lab, Closest Hospital, Destination, STEMI

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