- 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.
- 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.
- 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).
- Traumatic and nonadult arrests not investigated.