facilities [119–122].
Cardiac arrest referral centers
The management of the post‐cardiac arrest patient is a low‐frequency, resource‐intensive event requiring regimented, multidisciplinary strategies to optimize outcome [120–122]. One retrospective study has demonstrated that the risk of rearrest during prolonged air medical transport is low, but critical events such as hypotension or hypoxemia were encountered in 23% of patients [123]. Because many hospitals cannot provide these services at all hours, some systems have regionalized the care of post cardiac arrest patients [124]. EMS medical directors should consider developing policy regarding the proper destination for post cardiac arrest patients in their systems. Recent data have shown lower mortality in patients either directly transported or transferred early in the post resuscitation course to a cardiac arrest–receiving center (hazard ratio for mortality 0.84; 95% CI 0.74‐0.94) [125].
Summary
Successful resuscitation of patients from out‐of‐hospital cardiac arrest requires a comprehensive system of care. EMS clinicians face many practical and logistical challenges in in the field, but intense, focused resuscitation efforts can improve the bleak rate of survival from this condition. Prompt initiation and continuous delivery of high‐quality chest compressions, timely defibrillation, avoidance of hyperventilation and appropriate post cardiac arrest care are the keys to successful outcomes.
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