This study by Peters et al. (2026), published in Prehospital Emergency Care, is the first nationwide analysis of cardiac arrest occurring during interfacility transport (IFT) by EMS, finding that critical care transport (CCT) was associated with more than double the odds of ROSC compared to ALS (aOR 2.21, 95% CI 1.42–3.48), while BLS care was associated with significantly worse outcomes.

Overall ROSC rate: 50.3% — broken down as 32.9% (BLS), 45.3% (ALS), and 59.5% (CCT)

Additional Information

From over 54 million EMS encounters, they identified 1,466 cases where cardiac arrest was witnessed by the transporting EMS crew during an IFT.

Key Descriptive Findings

Level of care distribution: 7.5% BLS, 53.6% ALS, 38.9% CCT

Median age: 64 years (IQR 50–75); CCT patients were younger (median 61) than BLS (70) or ALS (66)

22.2% had a shockable initial rhythm

11.8% were trauma-associated

9.2% had a prior cardiac arrest before re-arresting during IFT — most commonly in the CCT group (14.9%), reflecting the higher acuity of patients selected for CCT

58.1% were transported by ground; 38.2% by rotor wing; 3.7% by fixed wing

14.7% involved a mechanical CPR device

Unshockable Rhythm Subgroup Analysis

A particularly notable finding was that the CCT advantage persisted — and was even more pronounced — in patients with unshockable initial rhythms (PEA/asystole):

CCT vs. ALS: aOR 2.65 (95% CI 1.64–4.33)

BLS vs. ALS: aOR 0.47 (95% CI 0.21–1.03, borderline non-significant)

Ground vs. air: aOR 0.61 (95% CI 0.38–0.97)

The authors hypothesize this reflects CCT clinicians' ability to titrate multiple vasopressors — particularly important for managing pseudo-PEA associated with profound hypotension — as well as the benefit of having a second clinician in the patient compartment enabling parallel task completion and redundant monitoring.

References

Peters, G. A., Misra, A. J., Samadian, K. D., Chang, W., Chandran, K. G., Hurwitz, J. A., … Cash, R. E. (2026). Cardiac Arrest During Interfacility Transport with Emergency Medical Services: A Preliminary Nationwide Cross-Sectional Study. Prehospital Emergency Care, 1–6. https://doi.org/10.1080/10903127.2026.2690618