Optimal Trip Destination
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
30 day mortality
|
Patient
|
PH-Paramedic & CCT
|
Patterson T, Perkins GD, Perkins A, et al. Expedited transfer to a cardiac arrest centre for non-ST-elevation out-of-hospital cardiac arrest (ARREST): a UK prospective, multicentre, parallel, randomised clinical trial. Lancet August 2023. Medline
|
I
|
Neutral (Yellow)
|
30 day mortality
|
Patient
|
ICU
|
Abusnina W, Al-Abdouh A, Latif A, Alkhouli M, Alraies MC, Daggubati R, et al. Timing of Coronary Angiography in Patients Following Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: A Systematic Review and Meta-Analysis of Randomized Trials. Cardiovasc Revasc Med 2022; 40:92–8. Medline
|
II
|
Supportive (Green)
|
Survival to discharge
|
Patient
|
PH-Paramedic
|
Cha WC., Lee SC., Shin SD., Song KJ., Sung AJ., Hwang SS. Regionalisation of out-of-hospital cardiac arrest care for patients without prehospital return of spontaneous circulation. Resuscitation 2012; 83(11):1338-42. Medline
|
II
|
Supportive (Green)
|
Survival to hospital discharge
|
Patient
|
PH-Paramedic
|
Cournoyer A., Notebaert E., de ML, Ross D., Cossette S., Londei-Leduc L., et al. Impact of the direct transfer to percutaneous coronary intervention-capable hospitals on survival to hospital discharge for patients with out-of-hospital cardiac arrest. Resuscitation 2018; 125 28-33. Medline
|
II
|
Supportive (Green)
|
ROSC
|
Patient
|
PH-Paramedic
|
Davis DP., Fisher R., Aguilar S., Metz M., Ochs G., McCallum-Brown L., Ramanujam P., Buono C., Vilke GM., Chan TC., Dunford JV. The feasibility of a regional cardiac arrest receiving system. Resuscitation 2007; 74:44-51. Medline
|
II
|
Supportive (Green)
|
Neurological function at 1 month
|
Patient
|
PH-Paramedic
|
Kajino K. OOHCA Impact transportation to critical care centres OOHCA. Resuscitation 2010; 81:549-54. Medline
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
Other
|
Karasek J, Seiner J, Renza M, Salanda F, Moudry M, Strycek M, et al. Bypassing out-of-hospital cardiac arrest patients to a regional cardiac center: Impact on hemodynamic parameters and outcomes. Am J Emerg Med 2021; 44:95–9. Medline
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
|
Kragholm K., Malta HC., Dupre ME., Xian Y., Strauss B., Tyson C., et al. Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest. Circulation Cardiovascular Quality and Outcomes 2017; 10(6). Medline
|
II
|
Supportive (Green)
|
Survival to admission/ discharge
|
Patient
|
PH-Paramedic
|
Ro YS., Shin SD., Song KJ., et al. A comparison of outcomes of out-of-hospital cardiac arrest with non-cardiac etiology between emergency departments with low- and high-resuscitation case volume. Resuscitation 2012; 83(7):855-61. Medline
|
II
|
Supportive (Green)
|
Survival to discharge
|
Patient
|
PH-Paramedic
|
Spaite DW., et al. Effect of transport interval on OOHCA survival in the OPALS study: implications for triaging patients to specialized cardiac arrest centers. Ann Emerg Med 2008; 54(2): 248-55. Medline
|
II
|
Supportive (Green)
|
Survival to discharge
|
Process
|
PH-Paramedic
|
von Vopelius-Feldt J, Perkins GD, Benger J. Association between admission to a cardiac arrest centre and survival to hospital discharge for adults following out-of-hospital cardiac arrest: A multi-centre observational study. Resuscitation 2021; 160:118-25. Medline
|
II
|
Supportive (Green)
|
Survival to 30 days
|
Patient
|
PH-Paramedic
|
Yeo JW, Ng ZHC, Goh AXC, Gao JF, Liu N, Lam SWS, et al. Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. J Am Hear Assoc 2021; e023806. Medline
|
II
|
Neutral (Yellow)
|
Survival
|
Patient
|
PH-Paramedic
|
Dicker B, Garrett N, Howie G, et al. Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study. Resusc Plus April 2024; 18:100625. Medline
|
III
|
Neutral (Yellow)
|
All cause mortality
|
Patient
|
PH-Paramedic
|
Iqbal MB., Al-Hussaini A., Rosser G., et al. Predictors of survival and favorable functional outcomes after an out-of-hospital cardiac arrest in patients systematically brought to a dedicated heart attack center (from the harefield cardiac arrest study). Am J Cardiol 2015; 115(6):730-7. Medline
|
Oxygen-high flow
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Neutral (Yellow)
|
Post arrest 30 day survival relative to FiO2
|
Process
|
PH-Paramedic
|
Xu Y, Peng F, Wang S, Yu H. Lower versus higher oxygen targets after resuscitation from out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. J Crit Care February 2024; 79:154448. Medline
|
I
|
Opposes (Red)
|
Serum markers for neuronal injury
|
Process
|
PH-Paramedic
|
Kuisma M., et al. Comparison of 30 and 100% inspired oxygen concentrations during early post-resuscitation period: a randomized controlled pilot study. Resus 2005; 69:199-206. Medline
|
II
|
Neutral (Yellow)
|
Survival to hospital discharge
|
Patient
|
PH-Paramedic
|
Bernard SA, Bray JE, Smith K, Stephenson M, Finn J,, et al. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA Nov 2022; 328(18):1818–26. Medline
|
II
|
Neutral (Yellow)
|
Neurological outcome at 6 months,
|
Patient
|
In-Patient
|
Ebner F., Ulln S., Neman A., Cronberg T., Mattsson N., Friberg H., et al. Associations between partial pressure of oxygen and neurological outcome in out-of-hospital cardiac arrest patients an explorative analysis of a randomized trial. Crit Care 2019; 23(1) 30. Medline
|
II
|
Opposes (Red)
|
30-day survival
|
Patient
|
ICU
|
Awad A, Nordberg P, Jonsson M, et al. Hyperoxemia after reperfusion in cardiac arrest patients: a potential dose-response association with 30-day survival. Crit Care March 2023; 27(1):86. Medline
|
III
|
Supportive (Green)
|
SpO2 =94% on arrival at hospital
|
Patient
|
PH-Paramedic
|
Bray JE., Hein C., Smith K., Stephenson M., Grantham H., Finn J., et al. Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial). Resuscitation 2018; 128:211-5. Medline
|
III
|
Opposes (Red)
|
No Change in the 3x3 table
|
Patient
|
PH-Paramedic
|
Smida T, Menegazzi JJ, Crowe RP, Bardes J, Scheidler JF, Salcido DD. Association of prehospital post-resuscitation peripheral oxygen saturation with survival following out-of-hospital cardiac arrest. Resuscitation Dec 2022; 181:28-36. Medline
|
Post-arrest cooling
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Neurologic outcome
|
Patient
|
ED-MD
|
Arrich J., Holzer M., Herkner H., Mullner M. Hypothermia for Neuroprotection in Adults after Cardiopulmonary Resuscitation. The Cochrane Library 2010; 110(4):1239. Medline
|
I
|
Supportive (Green)
|
Survival to discharge with good neuro outcomes
|
Patient
|
PH-Paramedic
|
Bernard SA., Gray TW., Buist MD., et al. Treatment of Comatose Survivors of Out-of hospital Cardiac Arrest with Induced Hypothermia N Engl J Med 2002; 346(8):557-63. Medline
|
I
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic
|
Cullen D., et al. Therapeutic Hypothermia Initiated in the Prehospital Setting: A Meta-Analysis. AENJ 2011; 33(4):314-21. Medline
|
I
|
Supportive (Green)
|
Feasibility
|
Process
|
ICU
|
Diao M., Huang F., Guan J., et al. Prehospital therapeutic hypothermia after cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. Resuscitation 2013; 84(8):1021-8. Medline
|
I
|
Supportive (Green)
|
Temperature at arrival to ED
|
Process
|
PH-Paramedic
|
Kamarainan A., Virkkinun I., Tenhunen J., Yli-Hankala A., Silfvast T. Prehospital therapeutic hypothermia for comatose survivors of cardiac arrest: A randomized controlled trial. Acta Anaesthesiol Scand 2009; 53(7):900-7. Medline
|
I
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic
|
Kim F., et al. Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4C saline. Circ 2007; 115:3064-70. Medline
|
I
|
Supportive (Green)
|
Favorable neurologic outcome within six months of cardiac arrest
|
Patient
|
ED-MD
|
The Hypothermia after Cardiac Arrest Study Group. Mild Therapeutic Hypothermia to Improve the Neurologic outcome after cardiac arrest. New England Journal of Medicine2002; 346(8):549-556. Medline
|
I
|
Neutral (Yellow)
|
Long term and short term survival as well as neurological status.
|
Patient
|
|
Arrich J., Holzer M., Havel C., Warenits AM., Herkner H. Pre-hospital versus in-hospital initiation of cooling for survival and neuroprotection after out-of-hospital cardiac arrest. The Cochrane database of systematic reviews 2016. Medline
|
I
|
Neutral (Yellow)
|
Functional outcome at discharge
|
Patient
|
PH-Paramedic
|
Bernard SA., Smith K., Cameron P., Masci K., Taylor DM., Cooper DJ., et al. Induction of prehospital therapeutic hypothermia after resuscitation from nonventricular fibrillation cardiac arrest*. Crit Care Med 2012; 40(3):747-53. Medline
|
I
|
Neutral (Yellow)
|
Functional outcome at discharge
|
Patient
|
PH-Paramedic
|
Bernard SA., Smith K., Cameron P., Masci K., Taylor DM., Cooper DJ., et al. Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial. Circulation 2010; 122(7):737-42. Medline
|
I
|
Neutral (Yellow)
|
Short, mid, and long term survivial
|
Patient
|
Other
|
Granfeldt A, Holmberg MJ, Nolan JP, Soar J, Anderson LW. Targeted temperature management in adult cardiac arrest: Systematic review and meta-analysis. Resuscitation 2021; 167:160–72. Medline
|
I
|
Neutral (Yellow)
|
Survival to hospital discharge
|
Patient
|
PH-Paramedic
|
Hunter BR., O'Donnell DP., Allgood KL., Seupaul RA. No benefit to prehospital initiation of therapeutic hypothermia in out-of-hospital cardiac arrest: A systematic review and meta-analysis. Acad Emerg Med 2014; 21(4):355-64. Medline
|
I
|
Neutral (Yellow)
|
survival to hospital discharge
|
Patient
|
PH-Paramedic
|
Kim F., Nichol G., Maynard C., et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: A randomized clinical trial. JAMA 2014; 311(1):45-52. Medline
|
I
|
Neutral (Yellow)
|
Successful TTM
|
Process
|
|
Scales DC., Cheskes S., Verbeek PR., Pinto R., Austin D., Brooks SC., et al. Prehospital cooling to improve successful targeted temperature management after cardiac arrest: A randomized controlled trial. Resuscitation 2017; 121:187-94. Medline
|
I
|
Neutral (Yellow)
|
6-month mortality
|
Patient
|
ICU
|
Shrestha DB, Sedhai YR, Budhathoki P, Gaire S, Adhikari A, Poudel A, Aryal BB, Yadullahi Mir WA, Dahal K, Kashiouris MG. Hypothermia versus normothermia after out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. Ann Med Surg 2022; 74:103327. Medline
|
I
|
Opposes (Red)
|
Survival with good neuro outcomes at discharge
|
Patient
|
ED-Paramedic & MD
|
Fernando SM, Do Santo P, Sadeghirad B, Lascarrou JB, Rochwerg B, Mathew R, et al. Targeted temperature management following out-of-hospital cardiac arrest: a systematic review and network meta-analysis of temperature targets. Intensive Care Med 2021; 47(10):1078–88. Medline
|
II
|
Supportive (Green)
|
Good neurological outcome
|
Patient
|
|
Choi SW., Shin SD., Ro YS., Song KJ., Lee EJ., Ahn KO. Effect of therapeutic hypothermia on the outcomes after out-of-hospital cardiac arrest according to initial ECG rhythm and witnessed status: A nationwide observational interaction analysis. Resuscitation 2016; 100:51-9. Medline
|
II
|
Supportive (Green)
|
Survival to hospital discharge
|
Patient
|
|
Rao MP., Dupre ME., Pokorney SD., Hansen CM., Tyson C., Monk L., et al. Therapeutic Hypothermia for Patients with Out-of-Hospital Cardiac Arrest in North Carolina. PEC 2016; 20(5):630-6. Medline
|
II
|
Supportive (Green)
|
Decrease of tympanic temperature
|
Patient
|
PH-Paramedic
|
Skulec R., Truhlar A., Seblova J., Dostal P., Cerny V. Pre-hospital cooling of patients following cardiac arrest is effective using even low volumes of cold saline. Crit Care 2010; 14(6):R231. Medline
|
II
|
Supportive (Green)
|
Survival to discharge
|
Patient
|
ICU
|
Wang CJ., Yang SH., Lee CH., Lin RL., Peng MJ., Wu CL. Therapeutic hypothermia application vs standard support care in post resuscitated out-of-hospital cardiac arrest patients. Am J Emerg Med 2013; 31(2):319-325. Medline
|
II
|
Neutral (Yellow)
|
Efficacy and Safety
|
Process
|
PH-Paramedic
|
Hammer L., Vitrat F., Savary D., et al. Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest. Am J Emerg Med 2009; 27(5):570-3. Medline
|
II
|
Neutral (Yellow)
|
Long term quality of life
|
Patient
|
|
Patel JK., Parikh PB. Association between therapeutic hypothermia and long-term quality of life in survivors of cardiac arrest: A systematic review. Resuscitation 2016; 103:54-9. Medline
|
II
|
Neutral (Yellow)
|
Time from ROSC to target temperature (33.9 C).
|
Process
|
ED-Paramedic & MD
|
Uray T, Mayr FB, Stratil P, Aschauer S, Testori C, Sterz F, et al. Prehospital surface cooling is safe and can reduce time to target temperature after cardiac arrest. Resuscitation 2015; 87:51-6. Medline
|
II
|
Neutral (Yellow)
|
30-day survival with favourable neurological outcome
|
Process
|
PH-Paramedic
|
Watanabe M, Matsuyama T, Oe H, Sasaki M, Nakamura Y, Miyamoto Y, et al. Impact of cooling method on the outcome of initial shockable or non-shockable out of hospital cardiac arrest patients receiving target temperature management: a nationwide multicentre cohort study. Ann Intensive Care 2021; 11(1):163. Medline
|
II
|
Neutral (Yellow)
|
Survival, Neurological outcome
|
Patient
|
ICU
|
Wolfrum S., Pierau C., Radke PW., Schunkert H., Kuorwski V. Mild therapeutic hypothermia in patients after OOHCA due to STEMI undergoing immediate PCI. Crit Care Med 2008; 36:1780-6. Medline
|
II
|
Opposes (Red)
|
Mortality
|
Patient
|
|
Hovdenes J., Roysland K., Nielsen N., Kjaergaard J., Wanscher M., Hassager C., et al. A low body temperature on arrival at hospital following out-of-hospital-cardiac-arrest is associated with increased mortality in the TTM-study. Resuscitation 2016; 107:102-6. Medline
|
III
|
Supportive (Green)
|
Temperature change, survival
|
Process
|
PH-Paramedic
|
Cabanas JG., Brice JH., De Maio VJ., Myers B., Hinchey PR. Field-induced therapeutic hypothermia for neuroprotection after out-of hospital cardiac arrest: A systematic review of the literature. J Emerg Med 2011; 40(4):400-9. Medline
|
III
|
Supportive (Green)
|
Feasibility
|
Process
|
ED-MD
|
Hachimi-Idrissi S., Corne L., Ebinger G., Michotte Y., Huyghens L. Mild hypothermia induced by a helmet device: A clinical feasibility study. Resuscitation 2001; 51(3):275-81. Medline
|
III
|
Supportive (Green)
|
Survival to discharge
|
Patient
|
ED-MD
|
Silfvast T., Tiainen M., Poutiainen E., Roine RO. Therapeutic hypothermia after prolonged cardiac arrest due to non-coronary causes. Resus 2003; 57:109-12. Medline
|
III
|
Supportive (Green)
|
Feasibility
|
Process
|
PH-Paramedic
|
Uray T., Malzer R. Out-of-hospital surface cooling to induce mild hypothermia in human cardiac arrest: a feasibility trial. Resus 2008; 77:331-8. Medline
|
III
|
Supportive (Green)
|
Feasibility
|
Patient
|
PH-Paramedic
|
Virkkunen I., Yli-Hankala A., Silfvast T. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer's solution: a pilot study. Resus 2004; 62:299-302. Medline
|
III
|
Supportive (Green)
|
30 Day Survival
|
Patient
|
PH-Paramedic
|
Werling M., Thoren AB., Axelsson C., Herlitz J. Treatment and outcome in post-resuscitation care after OOHCA when a modern therapeutic approach was introduced. Resus 2007; 73:40-5. Medline
|
III
|
Neutral (Yellow)
|
Target Temperature
|
Process
|
PH-Paramedic
|
Kamarainen A., et al. Prehospital induction of therapeutic hypothermia during CPR: A pilot study. Resus 2008; 76:360-3. Medline
|
III
|
Neutral (Yellow)
|
Feasibility
|
Patient
|
PH-Paramedic
|
Storm C., et al. Prehospital cooling with hypothermia caps (PreCoCa): a feasibility study. Clin Res Cardiol 2008; 97(10):768-72. Medline
|
III
|
Neutral (Yellow)
|
Survival
|
Patient
|
Other
|
Suen KF., Leung R., Leung LP. Therapeutic Hypothermia for Asphyxial Out-of-Hospital Cardiac Arrest Due to Drowning A Systematic Review of Case Series and Case Reports. Therapeutic hypothermia and temperature management 2017; 7(4) 210-21. Medline
|
III
|
Neutral (Yellow)
|
Favorable neurological recovery
|
Patient
|
Other
|
Wheelock KM, Chan PS, Chen L, de Lemos JA, Miller PE, et al. Time in therapeutic range for targeted temperature management and outcomes following out-of-hospital cardiac arrest. Resuscitation 2023; 182:109650. Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Taccone FS, Cariou A, Zorzi S, Friberg H, et al. Hypothermia versus normothermia in patients with cardiac arrest and shockable rhythm: a secondary analysis of the TTM-2 study. Crit Care 2024; 28(1):335. Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Watanabe M, Matsuyama T, Oe H, Sasaki M, Nakamura Y, Miyamoto Y, et al. Impact of cooling method on the outcome of initial shockable or non-shockable out of hospital cardiac arrest patients receiving target temperature management: a nationwide multicentre cohort study. Ann Intensive Care 2021; 11(1):163. Medline
|
Post-Arrest Cooling (CCT)
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Temperature at arrival to ED
|
Process
|
PH-Paramedic
|
Kamarainan A., Virkkinun I., Tenhunen J., Yli-Hankala A., Silfvast T. Prehospital therapeutic hypothermia for comatose survivors of cardiac arrest: A randomized controlled trial. Acta Anaesthesiol Scand 2009; 53(7):900-7. Medline
|
I
|
Neutral (Yellow)
|
All-cause mortality
|
Patient
|
|
Mahmoud A., Elgendy IY., Bavry AA. Use of Targeted Temperature Management After Out-of-hospital Cardiac Arrest: A Meta-Analysis of Randomized Controlled Trials. Am J Med 2016; 129(5):522-7.e2. Medline
|
I
|
Neutral (Yellow)
|
Mortality
|
Process
|
ICU
|
Shrestha DB, Sedhai YR, Budhathoki P, Gaire S, Adhikari A, Poudel A, Aryal BB, Yadullahi Mir WA, Dahal K, Kashiouris MG. Hypothermia versus normothermia after out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. Ann Med Surg 2022; 74:103327. Medline
|
I
|
Opposes (Red)
|
24 hour post-ROSC lactate levels
|
Process
|
ED-MD
|
Lee BK, Cho IS, Oh JS, Choi WJ, Wee JH, Kim CS, et al. Continuous neuromuscular blockade infusion for out-of-hospital cardiac arrest patients treated with targeted temperature management: A multicenter randomized controlled trial. PloS one 2018; 13(12):e0209327. Medline
|
II
|
Neutral (Yellow)
|
Survival
|
Patient
|
ED-MD
|
Hsu CH., Haac B., McQuillan KA., Tisherman SA., Scalea TM., Stein DM. Outcome of suicidal hanging patients and the role of targeted temperature management in hanging-induced cardiac arrest. The journal of trauma and acute care surgery. 2017;82(2):387-391. Medline
|
II
|
Neutral (Yellow)
|
30-day survival
|
Patient
|
|
Martinell L., Herlitz J., Karlsson T., Nielsen N., Rylander C. Mild induced hypothermia and survival after out-of-hospital cardiac arrest. Am J Emerg Med 2017; 35(11):1595-600. Medline
|
II
|
Neutral (Yellow)
|
Mortality and poor neurologic outcome.
|
Patient
|
|
Stanger D., Mihajlovic V., Singer J., Desai S., El-Sayegh R., Wong GC. Effects of targeted temperature management on mortality and neurological outcome: A systematic review and meta-analysis. Eur Heart J Acute Cardiovasc Care 2018; 7(5):467-477. Medline
|
III
|
Supportive (Green)
|
Survival
|
Patient
|
|
Godinjak A., Iglica A., Kukuljac A., Tančica I., Jusufović S., Ajanović A., Rožajac Š. Targeted temperature management after out-of-hospital cardiac arrest in three young patients. Acta medica academica 2017; 46(1):50-4. Medline
|
III
|
Neutral (Yellow)
|
Feasibility, Temperature change
|
Process
|
PH-Paramedic
|
Bruel C., Parienti JJ., Marie W., et al. Mild hypothermia during advanced life support: A preliminary study in out-of-hospital cardiac arrest. Crit Care 2008; 12(1):R31. Medline
|