Johannes von Vopelius-Feldt1, Janet Brandling2, Jonathan Benger3. 1. Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom. Electronic address: johannes.vonvopelius-feldt@uwe.ac.uk. 2. Faculty of Health & Applied Sciences, University of the West of England, Glenside Campus, BS16 1QY Bristol, United Kingdom. 3. Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom; Emergency Care, University of the West of England, Bristol, United Kingdom.
Abstract
BACKGROUND: Improving survival after out-of-hospital cardiac arrest (OHCA) is a priority for modern emergency medical services (EMS) and prehospital research. Advanced life support (ALS) is now the standard of care in most EMS. In some EMS, prehospital critical care providers are also dispatched to attend OHCA. This systematic review presents the evidence for prehospital critical care for OHCA, when compared to standard ALS care. METHODS: We searched the following electronic databases: PubMed, EmBASE, CINAHL Plus and AMED (via EBSCO), Cochrane Database of Systematic Reviews, DARE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, NIHR Health Technology Assessment Database, Google Scholar and ClinicalTrials.gov. Search terms related to cardiac arrest and prehospital critical care. All studies that compared patient-centred outcomes between prehospital critical care and ALS for OHCA were included. RESULTS: The review identified six full text publications that matched the inclusion criteria, all of which are observational studies. Three studies showed no benefit from prehospital critical care but were underpowered with sample sizes of 1028-1851. The other three publications showed benefit from prehospital critical care delivered by physicians. However, an imbalance of prognostic factors and hospital treatment in these studies systematically favoured the prehospital critical care group. CONCLUSION: Current evidence to support prehospital critical care for OHCA is limited by the logistic difficulties of undertaking high quality research in this area. Further research needs an appropriate sample size with adjustments for confounding factors in observational research design.
BACKGROUND: Improving survival after out-of-hospital cardiac arrest (OHCA) is a priority for modern emergency medical services (EMS) and prehospital research. Advanced life support (ALS) is now the standard of care in most EMS. In some EMS, prehospital critical care providers are also dispatched to attend OHCA. This systematic review presents the evidence for prehospital critical care for OHCA, when compared to standard ALS care. METHODS: We searched the following electronic databases: PubMed, EmBASE, CINAHL Plus and AMED (via EBSCO), Cochrane Database of Systematic Reviews, DARE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, NIHR Health Technology Assessment Database, Google Scholar and ClinicalTrials.gov. Search terms related to cardiac arrest and prehospital critical care. All studies that compared patient-centred outcomes between prehospital critical care and ALS for OHCA were included. RESULTS: The review identified six full text publications that matched the inclusion criteria, all of which are observational studies. Three studies showed no benefit from prehospital critical care but were underpowered with sample sizes of 1028-1851. The other three publications showed benefit from prehospital critical care delivered by physicians. However, an imbalance of prognostic factors and hospital treatment in these studies systematically favoured the prehospital critical care group. CONCLUSION: Current evidence to support prehospital critical care for OHCA is limited by the logistic difficulties of undertaking high quality research in this area. Further research needs an appropriate sample size with adjustments for confounding factors in observational research design.
Authors: Anssi Saviluoto; Johannes Björkman; Anna Olkinuora; Ilkka Virkkunen; Hetti Kirves; Piritta Setälä; Ilkka Pulkkinen; Päivi Laukkanen-Nevala; Lasse Raatiniemi; Helena Jäntti; Timo Iirola; Jouni Nurmi Journal: Scand J Trauma Resusc Emerg Med Date: 2020-05-29 Impact factor: 2.953
Authors: Lisa W M Leung; Ryan J Imhoff; Howard J Marshall; Diana Frame; Peter J Mallow; Laura Goldstein; Tom Wei; Maria Velleca; Hannah Taylor; Mark M Gallagher Journal: J Cardiovasc Electrophysiol Date: 2021-12-16 Impact factor: 2.942