Clinical resuscitation management of non-traumatic out-of-hospital cardiac arrests (OHCA) in Swiss emergency centres: a survey study.

Abstract

Introduction: Optimising cardiopulmonary resuscitation (CPR) management is crucial for out-of-hospital cardiac arrest (OHCA) survival but requires a clear understanding of the entire chain of survival. However, detailed OHCA management data from Swiss emergency centres (EC) are limited.

Methods: A nationwide cross-sectional survey was conducted among Level 1 and 2 ECs affiliated with the Swiss Society of Emergency and Rescue Medicine (SGNOR). The questionnaire covered key aspects of CPR management, including EC characteristics, team composition, resuscitation protocols and challenges pertaining to the year 2022. Analyses were performed using descriptive methods.

Results: Response rates were 94% (15/16) from Level 1 and 28% (10/36) from Level 2 ECs. CPR training is widely implemented with 90% of centres conducting emergency bay simulations. ACLS certification is mandated in 73% of Level 1 but only 20% of Level 2 centres. Team composition and debriefing practices vary with a structured debriefing absent in 67%/60% of Level 1/2 ECs. Mechanical chest compression devices are used in 80%/30% of ECs, while extracorporeal membrane oxygenation is available in 73%/10% ECs. Standard operating procedures are widely implemented, but 40%/60% of ECs lack structured OHCA databases. Challenges differ by Level, with Level 1 centres reporting variability in expertise due to frequently rotating staff and Level 2 centres highlighting staff shortages especially during night shifts. Decision-making challenges include termination of resuscitation, interdisciplinary coordination and post-resuscitation care. Research engagement is limited to 20% of Level 1 centres, but 93% of Level 1 and 50% of Level 2 ECs report willingness to engage in research projects under specific conditions, such as minimal time commitment.

Conclusion: Significant variability in CPR management, training and data collection exists across Swiss ECs. Standardised protocols, structured training and improved interdisciplinarity coordination are needed. Enhancing data registration and aligning practices with international guidelines could optimise patient outcomes, emphasising the need for further research and national standardisation efforts.