The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

Abstract

The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest. Resuscitation, 96. pp. 290-295. ISSN 0300-9572 Available from: http://eprints.uwe.ac.uk/29457We recommend you cite the published version. The publisher's URL is: http://dx.doi.org/10.1016/j.resuscitation.2015.08.020Refereed: Yes (no note) Disclaimer UWE has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material. UWE makes no representation or warranties of commercial utility, title, or fitness for a particular purpose or any other warranty, express or implied in respect of any material deposited. UWE makes no representation that the use of the materials will not infringe any patent, copyright, trademark or other property or proprietary rights. UWE accepts no liability for any infringement of intellectual property rights in any material deposited but will remove such material from public view pending investigation in the event of an allegation of any such infringement. PLEASE SCROLL DOWN FOR TEXT.The Impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest 1 THE IMPACT OF A PRE-HOSPITAL CRITICAL CARE TEAM ON SURVIVAL FROM OUT-OF- WORD COUNT, REFERENCES, FIGURES AND TABLES Abstract: 233Manuscript: 3045 ABSTRACT AimTo assess the impact of a pre-hospital critical care team (CCT) on survival from out-ofhospital cardiac arrest (OHCA). MethodsWe undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups. The primary outcome was survival to hospital discharge. All data were collected independently of the research. Results1851 cases of OHCA were included in the analysis, of which 1686 received ALS paramedic treatment and 165 were attended by both ALS paramedics and a CCT. Unadjusted rates of survival to hospital discharge were significantly higher in the CCT group, compared to the ALS paramedic group (15.8% and 6.5%, respectively, p < 0.001). After adjustment using multiple logistic regression, the effect of CCT treatment was no longer statistically significant (OR 1.54, 95% CI 0.89 to 2.67, p = 0.13). Subgroup analysis of OHCA with first monitored rhythm of ventricular fibrillation or pulseless ventricular tachycardia showed similar results. ConclusionPre-hospital critical care for OHCA was not associated with significantly improved rates of survival to hospital discharge. These results are in keeping with previously published studies.Further research with a larger sample size is required to determine whether CCTs can improve outcome in OHCA.The Impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest 3

33 Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest

“…[22][23][24] The other three studies did not demonstrate any difference in patientcentred outcomes after OHCA when comparing prehospital critical care with ALS. 17,20,21 We believe that the conflicting findings can be at least partially explained by study design and the logistics of prehospital care for OHCA.…”

“…21 Our pilot study showed that a sample size of about 6,000 would be required to detect an absolute improvement in survival of 3.5% with a power of 0.8. 17 We would argue that even smaller effects on survival of 1% to 2% absolute improvement would be clinically important, and require significantly larger studies. It is therefore possible that the conflicting findings are attributable to a type-2 error, with the three publications in support of prehospital critical care having a combined sample size of 111,394.…”

“…The three negative studies have a combined sample size of 3,214 after adjustment. 17,20,21 Likewise, the sample sizes of the conference abstracts range from 64 to 2,309. Olasveengen et al calculated that a sample size of 8,000 would be required to demonstrate a statistically significant difference in outcome in their patient population.…”

“…17 The standard EMS response to OHCA is ALS-trained paramedics, but during the study period a prehospital critical care service also attended about 9% of OHCAs. UK paramedics were trained and certified to follow the ALS algorithms, including intubation or use of a supraglottic airway and intravenous drug therapy.…”

“…10 In the UK, the availability of prehospital critical care is gradually increasing and provided by a combination of physicians and paramedics. 14,15 Without research to support the attendance of critical care teams at OHCA, 16,17 there is a large variation in the dispatch of prehospital critical care services in the UK and worldwide. This review aims to identify and present existing evidence regarding prehospital critical care for OHCA, when compared to standard ALS care.…”