Improving Survival After Out-of-Hospital Cardiac Arrest With a New Prehospital Care Protocol Using Evidence-Based Strategies for Post-Resuscitation Treatment by Emergency Medical Services

What this Trial Is About

Out-of-hospital cardiac arrest OHCA is a serious emergency condition with low survival rates despite improvements in resuscitation. Many patients experience rearrest after return of spontaneous circulation ROSC, which greatly reduces chances of survival. This research evaluates a new evidence-based prehospital care protocol led by paramedics to reduce rearrest and improve outcomes in adult OHCA patients transported to Siriraj Hospital in Thailand. The study compares outcomes before and after implementing the new prehospital post-resuscitation care protocol. This protocol includes structured monitoring, specific oxygen and ventilation targets, use of vasopressors like norepinephrine, fluid management support, team communication, and training workshops with simulations. The intervention group receives this protocol, while the comparison group receives conventional post-cardiac arrest care by advanced life support units. Participants are monitored for rearrest occurrence within one hour after ROSC during prehospital and emergency department care. Researchers will also assess survival to hospital admission and discharge, as well as how well providers comply with the protocol. The study enrolls adults aged 18 and older with OHCA who achieved ROSC before hospital arrival. Total participation spans from pre-implementation data collection to two years of post-implementation follow-up. The goal is to inform scalable EMS guidelines that improve quality and survival in resource-limited settings.

Resuscitation Enhancement to Avoid Rearrest Through Evidence-based Strategies in Prehospital Post-resuscitation Care