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

von Vopelius-Feldt, Johannes; Brandling, Janet; Benger, Jonathan

Abstract

© 2017 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.

Citation

von Vopelius-Feldt, J., Brandling, J., & Benger, J. (2017). Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest. Resuscitation, 114, 40-46. https://doi.org/10.1016/j.resuscitation.2017.02.018

• Journal Article Type: Review
• Acceptance Date: Feb 21, 2017
• Online Publication Date: Feb 27, 2017
• Publication Date: May 1, 2017
• Deposit Date: Mar 17, 2017
• Publicly Available Date: Mar 20, 2017
• Journal: Resuscitation
• Print ISSN: 0300-9572
• Electronic ISSN: 1873-1570
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 114
• Pages: 40-46
• DOI: https://doi.org/10.1016/j.resuscitation.2017.02.018
• Keywords: out-of-hospital cardiac arrest, EMS, advanced life support, prehospital critical care, HEMS, air ambulance
• Public URL: https://uwe-repository.worktribe.com/output/886987
• Publisher URL: http://dx.doi.org/10.1016/j.resuscitation.2017.02.018