to: acad-ae-med
At last a paper that shows the benefits of having paramedic interventions at
a cardiac arrest (odds ratio of 6.9) and when another pair of trained hands
helped it was even better. However, the technician control group did have
less VF patients. Those attended by Doctors had a much better outcome but
were more likely to have received bystander CPR. Some benefit must also be
due to the fact that it is an extra pair of hands, especially during the
journey. I have always suspected that CPR cannot be at its best when single
rescuer in back of moving vehicle.
Interestingly they did show that the technician who then calls for a
paramedic back up, resulted in more patients arriving at hospital alive BUT
most of these died shortly after arrival in hospital and so the overall
mortality was not improved over technician care. So best for technicians
just to defib, BLS with BVM ventilation and move, unless in difficult
circumstances to move patient.
The overall survival was still only 6.1% to hospital discharge- so it is
still better to collapse in Seattle than in Nottingham.
It also points out that doctors spent as long on scene as paramedics.
The paper is available in full text via:
http://www.heartjnl.com/cgi/content/abstract/81/1/47
results abstract is below.
Dr Matthew Cooke
Editor, Pre-hospital Immediate Care, BMJ Specialist Journals
www.prehospimmedicare.com
Abstract;
Multivariate logistic regression analysis showed that the chances of those
resuscitated by technician crew reaching hospital alive were poor but were
greater when paramedic crew were either called to assist technicians or
dealt with the arrest themselves (odds ratio 6.9 (95% confidence interval
3.92 to 26.61)). Compared to technician crew, survival to hospital discharge
was only significantly improved with paramedic crew (3.55 (1.62 to 7.79))
and further improved when paramedics were assisted by either a health
professional (9.91 (3.12 to 26.61)) or a medical practitioner (20.88 (6.72
to 64.94)).
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