Objective Post-resuscitation care may influence outcome following transport to hospital after resuscitation from out-of-hospital cardiac arrest (OHCA). This study aimed to determine whether receiving hospital characteristics such as 24-h cardiac catheterisation services, total bed number or OHCA patient volume influence the rate of survival. Setting Data were analysed from the Victorian Ambulance Cardiac Arrest Registry of patients from January 2003 to March 2010 who were transported to hospital with return of spontaneous circulation (ROSC) after OHCA. Results Ambulance paramedics attended 9971 patients with OHCA of suspected cardiac cause during the study period. Of these, 2902 (29%) achieved ROSC and were transported to one of 70 hospitals. 1816 (63%) were treated at hospitals with 24-h cardiac interventional services. After adjusting for differences in baseline characteristics, hospital factors significantly associated with survival were treatment at hospitals with 24-h cardiac interventional services (OR 1.40; 95% CI 1.12 to 1.74, p=0.003) and patient reception between 08:00 and 17:00 hours (OR 1.34; 95% CI 1.10 to 1.64, p=0.004). OHCA patient volume and total hospital bed number were not independently associated with outcome. Conclusion Hospital characteristics are associated with improved survival in patients with OHCA. This finding has implications for the establishment of regionalised systems of care for patients who have been resuscitated from OHCA.

Multidisciplinary trauma teams coordinate the reception and resuscitation of the seriously injured at the time when patients are most at risk of preventable morbidity and mortality by simultaneously determining therapeutic and diagnostic pathways.^1,2 Errors occur because of time pressure, inexperience, reliance on memory, multitasking, and failures in trauma team coordination, especially during the initial minutes of patient reception and resuscitation.^3-6

Cardiogenic shock is characterized by tissue hypoxia caused by circulatory failure arising from inadequate cardiac output. In addition to treating the pathologic process causing impaired cardiac function, prompt hemodynamic support is essential to reduce the risk of developing multiorgan dysfunction and to preserve cellular metabolism. Pharmacologic therapy with the use of vasopressors and inotropes is a key component of this treatment strategy, improving perfusion by increasing cardiac output, altering systemic vascular resistance, or both, while allowing time and hemodynamic stability to treat the underlying disease process implicated in the development of cardiogenic shock. Despite the use of mechanical circulatory support recently garnering significant interest, pharmacologic hemodynamic support remains a cornerstone of cardiogenic shock management, with over 90% of patients receiving at least 1 vasoactive agent. This review aims to describe the pharmacology and hemodynamic effects of current pharmacotherapies and provide a practical approach to their use, while highlighting important future research directions.