Out-of-Hospital Cardiac Arrest

Publication Date: May 1, 2020
Last Updated: March 14, 2022

Consensus statements on out of hospital cardiac arrest recommendations

Situational awareness in patients with OHCA

In all comatose OHCA patients, we recommend dynamic clinical decision-making of “definite” or “defer” transport to CCL based on situational awareness and assessment involving all clinical factors along the entire continuum of care.

OHCA patients with non-shockable rhythms

In OHCA patients with initial non-shockable rhythm, we recommended deferring transport to CCL at initial encounter.

OHCA patients with shockable rhythm and STEMI on Post ROSC ECG

In selected comatose OHCA patients with ROSC exhibiting STEMI on ECG we recommend a definite invasive strategy.

OHCA patients with shockable rhythm without STEMI on Post ROSC ECG

We recommend deferring invasive strategy at initial encounter in hemodynamically stable, comatose OHCA patients without STEMI on post ROSC ECG.

Access for intervention

In OHCA patients undergoing PCI, we recommend choosing the access site as per the operator's expertise and local standard catheterization lab protocols. For both routine femoral access and large bore access in case of hemodynamic support in patients with concomitant shock, we recommend the safe access site practices to reduce the risk of bleeding.

Antiplatelet therapy

We recommend ticagrelor or prasugrel as the preferred P2Y12 inhibitor in OHCA patients undergoing PCI.

Anticoagulation therapy

Among OHCA undergoing PCI we recommend the use of unfractionated heparin with monitoring as the peri-procedural anticoagulant given the availability of a reversal agent in cases of life threatening bleeding and reduced risk of acute stent thrombosis compared to bivalirudin.

Target temperature management (TTM)

  • We recommend against the use of prehospital TTM using cold intravenous crystalloids.
  • We recommend initiating TTM inpatient as soon as possible.

Barriers and Public Reporting

SCAI advocates making OHCA exclusion based on exceptional risk from public reporting analysis of PCI outcomes. The principle to be followed is that “Public reporting of outcomes in high-risk patients, if done at all, should accurately reflect the performance of those operators and institutions.” Additionally, SCAI recommends continuing to track process measures and outcomes in all patients suffering OHCA, including early access to coronary angiography and use of PCI.

Recommendation Grading



Out-of-Hospital Cardiac Arrest

Authoring Organization

Publication Month/Year

May 1, 2020

Last Updated Month/Year

July 10, 2023

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Emergency care, Home health, Long term care

Intended Users

Paramedic emt, medical assistant, nurse, nurse practitioner, physician, physician assistant


Counseling, Management

Diseases/Conditions (MeSH)

D058687 - Out-of-Hospital Cardiac Arrest


Out of hospital cardiac arrest (OHCA)