on pediatric readiness in emergency medical services systems.

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Introduction: Up to 40% of out-of-hospital cardiac arrest patients will re-arrest in the immediate post-return of spontaneous circulation (post-ROSC) period, and re-arrest is associated with decreased survival. Cardiac arrest guidelines are equivocal regarding what post-ROSC care should be provided in the prehospital setting and when hospital transport should occur. Prehospital protocols must balance the benefit of time-dependent hospital-based care with the risk of early re-arrest. We sought to describe current prehospital protocols for post-ROSC care. Hypothesis: Prehospital protocols for post-ROSC care will be variable. Methods: A single trained abstractor systematically reviewed a purposive sample of prehospital protocols for adult non-traumatic cardiac arrest from the United States using an a priori standardized data abstraction form. Protocols were either stand-alone or integrated into intra-arrest care. Exclusion criteria were non-911 ground transport agencies and protocols not revised since the 2015 guideline update. All protocols were publically available via the Internet. Data abstraction was conducted in May 2019. The number of protocols that met pre-defined criteria were counted and summarized. Results: We identified and reviewed 82 prehospital protocols from 46 states and the District of Columbia. Seven protocols were excluded due to the revision date, leaving 75 protocol included in the study (Table). Six protocols (8%) provide no guidance on prehospital post-ROSC care. ECG acquisition (63/75 [84%]) and transport to specific post-ROSC hospitals (overall 55/75 [73%], but 22/55 [40%] are only if STEMI present) are common but not universal. Only 9 (12%) provide any guidance on when to initiate transport post-ROSC, with 4 (5%) requiring a post-ROSC stabilization period of at least 5 minutes prior to transport. Conclusion: Prehospital treatment and transport protocols for post-ROSC care are highly variable across the United States.