An intra-arrest, secondary transfer of a patient for primary percutaneous coronary intervention case report

Background: It is known that patients in cardiac arrest who undergo pre-hospital transfer with cardiopulmonary resuscitation (CPR) ongoing have poor rates of survival. Secondary transfer of patients without sustained return of spontaneous circulation (ROSC), however, has limited description in the literature. This case demonstrates that an intra-arrest secondary transfer is not only possible but can be lifesaving for carefully selected patients. Case Description: A 57-year-old man underwent witnessed cardiac arrest whilst in the emergency department of a district general hospital. ROSC was achieved after 37 minutes, and an ST-elevation myocardial infarction (STEMI) was diagnosed. The patient, however, destabilised into further cardiac arrest before transfer to the local percutaneous coronary intervention (PCI) centre could occur. Despite CPR ongoing the patient demonstrated positive clinical signs including a good endtidal carbon dioxide (EtCO2) and reactive pupils; the decision was made to undertake a forty-two-mile secondary transfer to the PCI centre. The transfer was conducted by the regional adult critical care transfer team and CPR performed with a mechanical chest compression device. By the time of his arrival at the PCI centre, the patient had a cumulative arrest time of 175 minutes. The patient underwent primary PCI (PPCI) and after a prolonged stay in intensive care he was discharged home with a very good neurological outcome. Conclusions: Secondary transfer of patients to a PCI facility should be considered in patients with an ongoing cardiac arrest due to an STEMI. Patient selection is required based on clinical findings, but a good outcome is possible in these circumstances.