Abstract
Aim
To examine the effect of prehospital critical care on survival following OHCA, compared
to routine advanced life support (ALS) care.
Methods
We undertook a prospective multi-centre cohort study including two ambulance services
and six prehospital critical care services in the United Kingdom (UK), between September
2016 and October 2017. Inclusion criteria were adult patients with non-traumatic OHCA
treated by either prehospital critical care teams or ALS paramedics. Patients who
received prehospital critical care were matched to those receiving ALS using propensity
score matching. Primary outcome was survival to hospital discharge; secondary outcome
was survival to hospital admission.
Results
The primary analysis included 658 patients with OHCA receiving prehospital critical
care and 1847 patients receiving ALS care. Rates of survival to hospital discharge
(primary outcome) were 11.9% in both groups; rates of survival to hospital admission
(secondary outcome) were 34.4% and 27.7% in the prehospital critical care and ALS
group, respectively. The corresponding odds ratios for survival to hospital discharge
and survival to hospital admission with prehospital critical care were 1.06 (95% confidence
interval 0.75–1.49) and 1.39 (95% confidence interval 1.10–1.75), respectively. Results
were consistent across subgroups and sensitivity analyses.
Conclusions
Despite a positive association with the secondary outcome of survival to hospital
admission, prehospital critical care was not associated with increased rates of survival
to hospital discharge following OHCA.
Keywords
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Article info
Publication history
Published online: August 11, 2019
Accepted:
August 6,
2019
Received in revised form:
July 4,
2019
Received:
April 4,
2019
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2019 Elsevier B.V. All rights reserved.
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- Comment on: “The effect of prehospital critical care on survival following out of hospital cardiac arrest: A prospective observational study”ResuscitationVol. 145
- PreviewWe read the article “The effect of pre-hospital critical care on survival following out of hospital cardiac arrest: A prospective observational study”1 with great interest. The authors should be complimented for their effort to answer the question whether or not pre-hospital critical care teams contribute to the survival of out-of-hospital cardiac arrest (OHCA) patients. In their study, they could not demonstrate a positive association between pre-hospital critical care and survival to hospital discharge, which was their primary endpoint.
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