Written by Ketan Patel
Spoon Feed
This hypothesis-generating study showed that maintaining EMS pads and equipment during ED transfer for out-of-hospital cardiac arrests (OHCA) saved 143 seconds to first rhythm analysis and defibrillation.
Stay and play? With EMS equipment at least…
Prior work has classically taught us that every minute in delay to initial defibrillation in shockable OHCA equates to a 10% increase in mortality risk (3–15% range); however, the impact of swapping equipment during the ED handoff has never been analyzed.
This single-center, retrospective, video review study (n of 223 OHCA during a six year period) studied the difference between EMS equipment utilization for initial ED rhythm analysis versus switching to ED equipment. The EMS group (n=75) had a significantly shorter median time to first ED rhythm analysis (94 vs. 252 seconds; difference 143 seconds, 95%CI 116–169) and first ED defibrillation (120 vs. 255 seconds; difference 131.5 seconds, 95% CI 8–272). The EMS group also had higher rates of ED defibrillation (45.1% vs. 27.1%) and numerically improved survival to discharge (8.0% vs. 1.3%).
Limitations include retrospective design and single-center population being studied. There is also a huge difference between initial shockable rhythms for EMS versus in the ED (26.5% vs. 10.5%, respectively) creating an indication and selection bias. Thus, cross applicability and inference about survival and neurological outcome effects are significantly limited.
How will this change my practice?
Managing a cardiac arrest is akin to being a maestro in an orchestra. Every motion, order, direction, and team member needs to function in harmony to maintain order, optimize CPR, minimize delays to shock, and give the patient the best chance of survival. In shockable OHCA rhythms, I will consider keeping EMS pads on if transfer occurs proximate to a time of shock. This only highlights one of many potential delays that may occur when the resuscitation is not tightly woven and run with intention.
Source
Emergency Medical Services Equipment Use in the Emergency Department and Time to Care for Those With Out-of-Hospital Cardiac Arrest. Ann Emerg Med. 2026 Jun 10:S0196-0644(26)00255-6. doi: 10.1016/j.annemergmed.2026.04.011. Epub ahead of print. PMID: 42274435.
