UK ambulance service resuscitation management of pulseless electrical activity: a systematic review protocol of text and opinion

Abstract

Background: Out-of-hospital cardiac arrest patients with pulseless electrical activity are treated by paramedics using basic and advanced life support resuscitation. When resuscitation fails to achieve return of spontaneous circulation, there are limited evidence and national guidelines on when to continue or stop resuscitation. This has led to ambulance services in the United Kingdom developing local guidelines to support paramedics in the resuscitative management of pulseless electrical activity. The content of each guideline is unknown, as is any association between guideline implementation and patient survival. We aim to identify and synthesise local ambulance service guidelines to help improve the consistency of paramedic-led decision-making for the resuscitation of pulseless electrical activity in out-of-hospital cardiac arrest.Methods: A systematic review of text and opinion will be conducted on ambulance service guidelines for resuscitating adult cardiac arrest patients with pulseless electrical activity. Data will be gathered direct from the ambulance service website. The review will be guided by the methods of the Joanna Briggs Institute (JBI). The search strategy will be conducted in three stages: 1) a website search of the 14 ambulance services; 2) a search of the evidence listed in support of the guideline; and 3) an examination of the reference list of documents found in the first and second stages and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Each document will be assessed against the inclusion criteria, and quality of evidence will be assessed using the JBI Critical Appraisal Checklist for Text and Opinion. Data will be extracted using the JBI methods of textual data extraction and a three-stage data synthesis process: 1) extraction of opinion statements; 2) categorisation of statements according to similarity of meaning; and 3) meta-synthesis of statements to create a new collection of findings. Confidence of findings will be assessed using the graded ConQual approach.

The Regional Resuscitation Guidelines for Pulseless Electrical Activity in Emergency Medical Services in the United Kingdom: A Systematic Review

“…This review was conducted in accordance with the Joanna Briggs Institute (JBI) for systematic review of text and opinion (9) according to a priori published protocol (10). The review is registered on the international prospective register of systematic reviews (CRD42019138731).…”

Protocol for a scoping review on the development of policy, guidelines and protocols within emergency medical services

“…Two recent systematic reviews of evidence-based guidelines (EBGs) in pre-hospital care found that they frequently vary in quality and have noticeable gaps in their methodology and adherence to reporting standards ( Fishe et al, 2018 ; Turner et al, 2020 ). Even less is known about the development and quality of the individual policies, guidelines and protocols that guide clinical practice and service delivery within the confines of each EMS organisation ( Coppola et al, 2020 ). Hence, there is a need to better understand the process involved in the development of these documents within EMS to avoid unwarranted variation in EMS clinical practice.…”