Sudden cardiac arrest pharmacotherapy with prefilled syringes improves adherence to Advanced Life Support protocol in understaffed resuscitation pre-hospital care teams

Abstract

Every procedural facilitation or a change in available equipment in treatment of out-of-hospital arrest (OHCA) by two-person teams may significantly enhance their performance quality. The aim of this study was to assess the impact of adrenaline in prefilled syringes on improving the adherence to Advanced Life Support protocol by understaffed teams. The research was based on a randomized cross-over high-fidelity simulation study. Two-person teams took part in two 10-minute simulation scenarios featuring sudden cardiac arrest in ventricular fibrillation (VF). The control group (group C) had at its disposal standard ampoules, whereas the experimental group (group E) prefilled syringes. The execution times of CPR start, defibrillation shocks, intravenous (IV) access, epinephrine and amiodarone doses were measured. Additionally, the chest compression fraction (CCF) was calculated. The designed two-minute loops were considerably prolonged in group C. Nineteen teams (31.1%) in group C but 49 (80.3%) in group E carried out the fifth defibrillation (P < 0.001). After two minutes of CPR nobody in group C switched to perform chest compressions. IV access was obtained significantly earlier in group E (114.7 ± 52.2 sec) than in group C (150.2 ± 68.6 sec)(P = 0.002). Two doses of adrenaline were administered in group E, whereas its second dose only by 12 teams in group C. The simulation study has proved that for understaffed teams a use of prefilled syringes not only did enhance the flow of ALS procedure, but it also improved the quality of cardiopulmonary resuscitation.

Efficiency of two-member crews in delivering prehospital advanced life support cardiopulmonary resuscitation: A scoping review

“…Three simulation studies in two-member ALS teams focused on the effect of using pre-filled syringes with medication. 27 , 28 , 29 All three studies reported reduced time to adrenaline administration 27 , 28 , 29 , while two noted a shorter time to intravenous or intraosseous access. 27 , 29 One study found a higher chest compression fraction and quicker airway management.…”

“…Time to airway securing The use of multifunction pads: improved CC quality, earlier airway securing. Zalewski (2020C) 29 Paramedics ( n = 106) ALS/CPR with pre-filled medication syringes Time to critical interventions, CC quality measures The use of pre-filled syringes with adrenaline and amiodarone: faster achievement of critical interventions, CC quality did not differ. Legend.…”