• Adherence to resuscitation guidelines during prehospital care of cardiac arrest patients

    by Marc Colbeck. Last modified: 14/01/15

     

     
    Kirves H1, Skrifvars MB, Vähäkuopus M, Ekström K, Martikainen M, Castren M. Adherence to resuscitation guidelines during prehospital care of cardiac arrest patients. Eur J Emerg Med. 2007 Apr;14(2):75-81. PMID: 17496680.

    In this 2007 study the authors reviewed 157 cardiac arrests that occurred in the out of hospital setting over one year in Finland.  They retrospectively analysed two things: (1) if the care was compliant with the published standards post-ROSC and (2)  the outcomes of the patients (based on survival past 1 year post arrest).  They did not analyse if the care during the arrest was appropriate or not, only care after ROSC.

    They found that the post ROSC care wasn’t very good – clinicians managed to meet the standard of care only about 40% of the time – even though, the authors note their criteria for meeting the standard of care was fairly liberal. Interestingly, there was a physician on scene >83% of the time (depending on location). Some errors were pretty glaring, ROSC time was missing from the charts in 15% of the cases, only 58% of patients with ETI had EtCO2 monitoring, and about 1/3 of their ROSC patients did not get a 12 lead ECG, for example.

    They conclude that:

    …prehospital care unsatisfactorily compatible with the guidelines was independently associated with the risk of death during the period of postresuscitation hospital care.

    It’s important to clarify that this is a correlative relationship. The study was not strong enough to determine the presence or absence of a causative relationship.  Also, only post-ROSC in OHCA was evaluated, not care during the arrest.  However, one of the questions I’m curious about is “When clinicians (particularly paramedics) follow well-constructed, evidence-based CPGs, does it improve patient outcome?” and this study suggests that it probably does improve outcomes, although weakly.  So that’s helpful.

    The other take home message here, not directly related to my thesis, is that their prehospital clinicians (which included doctors in the overwhelming majority of cases) only followed the standards 40% of the time! The authors found that care was even worse in patients in asystole and PEA (vs VT/VF), unwitnessed arrest, females, and patients with neurological comorbidity prior to arrest.  It might be good for EMS clinical managers to take a closer look at the post-ROSC care of these patients particularly in their systems to ensure that they are up to the standards.

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    Marc Colbeck

    Marc Colbeck

    Senior Lecturer at Australian Catholic University
    Marc is a Canadian Critical Care Paramedic with 14 years of clinical experience who has been working as a professional educator since the early 2000's. He has taught at the College and University level in the Middle East and Australia, and worked as the General Manager of Clinical Governance for an Australian State Ambulance Service. He is currently a Senior Lecturer at Australian Catholic University in Queensland, Australia. His undergraduate degree is in PreHospital Care and his MA is in Counseling Psychology. He is currently working on a PhD in Translational Health Sciences with the Joanna Briggs Institute at the University of Adelaide, with a special interest in the development and maintenance of paramedic CPGs. His website is www.marccolbeck.info.

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