For nontraumatic OHCA, prehospital critical care adds little


  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For patients experiencing out-of-hospital cardiac arrest (OHCA), prehospital critical care may improve rates of survival to hospital admission, but not to discharge. 
  • Authors suggest reason may be that it takes longer for a critical care team vs an advanced life support (ALS) team to arrive on the scene.
  • “Prehospital critical care is very unlikely to be cost-effective," they wrote.

Why this matters

  • OHCA rate variability around the world has been attributed to prehospital care differences.
  • Studies suggesting prehospital critical care was beneficial were subject to unmeasured confounding.

Key results

  • On logistic regression analysis, critical care vs ALS:
    • Survival to discharge: OR, 1.06 (95% CI, 0.75-1.49; P=.75).
    • Survival to admission: OR, 1.39 (95% CI, 1.10-1.75; P=.005).
  • Similar results upon subgroup and sensitivity analyses.

Study design

  • Prospective 1-year multicenter cohort study of 2 ambulance and 6 prehospital critical care services in the UK (n=2505).
  • Critical care services staffed by specialist paramedics in critical care and emergency physicians, anesthesiologists, or intensivists with prehospital training.
  • Researchers used propensity matching to compare nontraumatic OHCA patients receiving field ALS vs field critical care.
  • Outcome: survival to hospital discharge.
  • Funding: National Institute for Health Research (UK).

Limitations

  • Traumatic and nonadult arrests not investigated.