LFR found that prehospital cardiac catheterization laboratory activation in patients suffering
a witnessed shockable cardiac arrest improves
survival. The survival improvement was most
dramatic in patients who experienced sustained
ROSC prior to hospital arrival.
Prompt cardiac catheterization laboratory intervention in sudden cardiac arrest patients provides numerous benefits. First, in our system,
the pathway to therapeutic hypothermia became
much more consistent since cooling catheters are
almost exclusively placed in the catheterization
lab upon conclusion of an intervention.
Therefore, taking the arrest patient directly
to the cardiac catheterization lab significantly
decreases the time needed for a patient to reach
Second, a high percentage of patients suffering from shockable cardiac arrest have a culprit
coronary artery lesion requiring primary percutaneous coronary intervention. By transporting
directly to the catheterization lab, the culprit vessel can be rapidly identified and opened leading
to improved post arrest cardiac function.
Third, catheterization lab intervention allows
for prompt placement of cardiovascular sup-
port devices such as a transvenous pacemaker,
a cardiac assist device such as Impella, or extra-
corporeal membrane oxygenation (ECMO)—all
of which may improve systemic blood flow and
Survival from sudden cardiac arrest is highly variable among communities and is represented by
the imagery of a chain of survival. If your community isn’t measuring cardiac arrest survival in
a standardized way, measurement is the first step
to making improvements.
We don’t have the luxury of trying to improve
only one variable, then waiting several years to
see if it made a difference. Improvements can be
made throughout every link in the chain.
Standardizing hospital best practices in receiving sudden cardiac arrest patients presents an
opportunity to improve survival at a system level.
By identifying a group of patients who were most
likely to survive witnessed, shockable cardiac
arrest and then immediately activating the cardiac catheterization laboratory, LFR was able to
improve survival rates without over-utilizing limited resources. ✚
Jason Kruger, MD, is the medical director for Lincoln
(Neb.) Fire & Rescue.
Scott Wiebe, EMT-P, is an EMS supervisor for Lincoln
(Neb.) Fire & Rescue.
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The cardiac catheterization lab at Nebraska Heart
Hospital can now be activated by paramedics in the
same manner as they activate it for a STEMI patient.