No pulse? No ride.
Cardiac patients who cannot be revived at home must be declared dead, according to jarring new orders given to EMS teams in New York.
Effective immediately, patients in cardiac arrest will not be transported to a hospital if first responders cannot get a pulse on their own while administering CPR, a new internal memo obtained by ABC News states. City hospitals are overrun with COVID-19 patients and some cardiac patients may not receive the medical care they need to survive.
“These orders are binding and the FDNY will devise a plan for implementation,” Deputy Fire Commissioner Frank Dwyer told ABC News.
In a blunt advisory on March 29, the Nassau County Regional Emergency Medical Advisory Committee on Long Island stated, “There is no medical benefit to transporting patients in cardiac arrest with CPR in progress.” The statement goes on to justify the new protocol with a statistic saying successful resuscitation rates increase when patients are not moved during CPR.
But is it true? Does the data support this?
It may be no big scandal, but a good way to get eyes on. How many victims without a pulse make it to the hospital, how many eventually recover?
Several studies have shown the incidence of PEA (pulseless electrical activity) in-hospital to be approximately 35% to 40% of arrest events. For out-of-hospital cardiac arrest, the incidence of PEA is 22% to 30%. PEA arrests are associated with a poor prognosis, with a survival to discharge rate between 2% and 5% for out-of-hospital cardiac arrest. In addition, pulseless electrical activity after countershock is correlated with a worse prognosis than PEA presenting as the initial rhythm, with 0% to 2% of patients in post-countershock PEA surviving to discharge.13 Furthermore, post-countershock PEA with a slow and wide complex rhythm is associated with a worsened prognosis compared to the rapid, narrow complex PEA.
No matter which way you look at it, the research on pre-hospital TOR (Termination of Resuscitation) is clear: OHCA (Out of Hospital Cardiac Arrest) patients who fulfill BLS or ALS TOR criteria most often do not survive to hospital discharge. Studies consistently show a survival of less than 0.5% if BLS TOR criteria are followed and 0% if ALS criteria are followed. Studies also show transportation rates of 40-60% if BLS criteria are followed and around 80% if ALS criteria are followed. In spite of this, research suggests that there are barriers to the implementation of TOR criteria by EMS providers.