The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest |
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| Institution: | 1. Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom;2. North Bristol NHS Trust, Southmead Road, BS10 5NB Bristol, United Kingdom;3. University of the West of England, Bristol, United Kingdom;1. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium;2. Department of Cardiovascular and Thoracic Surgery, Cardiovascular Anaesthesia and Intensive Care, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy;1. Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan;2. Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan;1. Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA;2. Department of Public Health, Tokyo Women’s Medical University, Tokyo, Japan;3. Kyoto University Health Service, Kyoto, Japan;4. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan |
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| Abstract: | AimTo assess the impact of a pre-hospital critical care team (CCT) on survival from out-of-hospital 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 0.89–2.67, 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. |
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| Keywords: | Out-of-hospital cardiac arrest Emergency medical systems Pre-hospital critical care Advanced life support |
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