¿Reanimar en el Sitio o Trasladar? uso De Isócronos para la Toma de Decisiones en la Reanimación Prehospitalaria: Análisis Desde Cali, Colombia

Out-of-hospital cardiac arrest is a medical emergency in which time constitutes a critical determinant of survival, with a progressive decrease in the probability of survival for each minute without effective circulation (Chocron et al., 2016; Rajan et al., 2016). Resuscitation guidelines recommend prioritizing on-scene resuscitation, assuming the availability of advanced life support (ALS) in the prehospital setting (Panchal et al., 2020). However, this premise is not always met in cities within middle-income countries, where prehospital care relies predominantly on basic life support ambulances. In this context, the decision not to transport during resuscitation also represents a clinical choice with significant consequences. This article argues that territorial accessibility to institutions capable of providing advanced resuscitation should be explicitly incorporated into decision-making processes. Based on a geospatial analysis using five-minute isochrones in Santiago de Cali, a critical reflection is proposed regarding the relevance of mixed models that integrate initial on-scene resuscitation with the possibility of timely transport to accessible hospital services.