Rationale and development of a prehospital goal‐directed bundle of care to prevent rearrest after return of spontaneous circulation

In patients with out-of-hospital cardiac arrest (OHCA) who attain return of spontaneous circulation (ROSC), rearrest while in the prehospital setting represents a significant barrier to survival. To date, there are limited data to guide prehospital emergency medical services (EMS) management immediately following successful resuscitation resulting in ROSC and prior to handoff in the emergency department. Post-ROSC care encompasses a multifaceted approach including hemodynamic optimization, airway management, oxygenation, and ventilation. We sought to develop an evidenced-based, goal-directed bundle of care targeting specified vital parameters in the immediate post-ROSC period, with the goal of decreasing the incidence of rearrest and improving survival outcomes. Here, we describe the rationale and development of this goal-directed bundle of care, which will be adopted by several EMS agencies within California. We convened a group of EMS experts, including EMS Medical Directors, quality improvement officers, data managers, educators, EMS clinicians, emergency medicine clinicians, and resuscitation researchers to develop a goal-directed bundle of care to be applied in the field during the period immediately following ROSC. This care bundle includes guidance for prehospital personnel on recognition of impending rearrest, hemodynamic optimization, ventilatory strategies, airway management, and diagnosis of underlying causes prior to the initiation of transport.

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Publication Details

Journal
Journal of the American College of Emergency Physicians Open
Published
2024-11-05
DOI
https://doi.org/10.1002/emp2.13321
Primary Topic
Cardiac Arrest and Resuscitation
Type
article
Field-Weighted Citation Impact
0.00

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article

Rationale and development of a prehospital goal‐directed bundle of care to prevent rearrest after return of spontaneous circulation

J. Joelle Donofrio-Ödmann, Katherine Staats, Kevin Mackey, S. Kidane et al.
Journal of the American College of Emergency Physicians Open
Cardiac Arrest and Resuscitation
article

Rationale and development of a prehospital goal‐directed bundle of care to prevent rearrest after return of spontaneous circulation

J. Joelle Donofrio-Ödmann, Katherine Staats, Kevin Mackey, S. Kidane, Clayton Kazan, Dustin W. Ballard, Shira Schlesinger, Keith Thompson, Nichole Bosson, Marianne Gausche‐Hill, James J. Menegazzi, Juan Carlos C. Montoy, Jake Toy, David Dillon, John F. Brown, Brian Morr
article en

Abstract

In patients with out-of-hospital cardiac arrest (OHCA) who attain return of spontaneous circulation (ROSC), rearrest while in the prehospital setting represents a significant barrier to survival. To date, there are limited data to guide prehospital emergency medical services (EMS) management immediately following successful resuscitation resulting in ROSC and prior to handoff in the emergency department. Post-ROSC care encompasses a multifaceted approach including hemodynamic optimization, airway management, oxygenation, and ventilation. We sought to develop an evidenced-based, goal-directed bundle of care targeting specified vital parameters in the immediate post-ROSC period, with the goal of decreasing the incidence of rearrest and improving survival outcomes. Here, we describe the rationale and development of this goal-directed bundle of care, which will be adopted by several EMS agencies within California. We convened a group of EMS experts, including EMS Medical Directors, quality improvement officers, data managers, educators, EMS clinicians, emergency medicine clinicians, and resuscitation researchers to develop a goal-directed bundle of care to be applied in the field during the period immediately following ROSC. This care bundle includes guidance for prehospital personnel on recognition of impending rearrest, hemodynamic optimization, ventilatory strategies, airway management, and diagnosis of underlying causes prior to the initiation of transport.

Journal of the American College of Emergency Physicians OpenVol. 5(6)
New York City Fire Department (US), Los Angeles County Museum of Art (US), Kaiser Permanente (US), University of California, Los Angeles (US), University of Pittsburgh (US), University of California, San Francisco (US), Sacramento City College (US), Contra Costa County Library (US), UCLA Medical Center (US), Felton Institute (US), Imperial Valley College (US), University of California San Diego (US), San Francisco Department of Public Health (US), Colorado Permanente Medical Group (US), Health and Human Services Agency (US), Pacific Research Group (United States) (US), Contra Costa Health Services (US), Janus University (US), Harbor–UCLA Medical Center (US), University of California, Davis (US)
National Heart, Lung, and Blood Institute
Openalex Percentile: Top 65%
Cardiac Arrest and Resuscitation
DOIOpen Access PDFOpenAlex
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