Abstract

BackgroundSurvival rates from out-of-hospital cardiac arrest (OHCA) remain low, despite remarkable efforts to improve care. A number of ambulance services in the United Kingdom (UK) have developed prehospital critical care teams (CCTs) which attend critically ill patients, including OHCA. However, current scientific evidence describing CCTs attending OHCA is sparse and research to date has not demonstrated clear benefits from this model of care.MethodsThis prospective, observational study will describe the effect of CCTs on survival from OHCA, when compared to advanced-life-support (ALS), the current standard of prehospital care in the UK. In addition, we will describe the association between individual critical care interventions and survival, and also the costs of CCTs for OHCA.To examine the effect of CCTs on survival from OHCA, we will use routine Utstein variables data already collected in a number of UK ambulance trusts. We will use propensity score matching to adjust for imbalances between the CCT and ALS groups. The primary outcome will be survival to hospital discharge, with the secondary outcome of survival to hospital admission.We will record the critical care interventions delivered during CCT attendance at OHCA. We will describe frequencies and aim to use multiple logistic regression to examine possible associations with survival.Finally, we will undertake a stakeholder-focused cost analysis of CCTs for OHCA. This will utilise a previously published Emergency Medical Services (EMS) cost analysis toolkit and will take into account the costs incurred from use of a helicopter and the proportion of these costs currently covered by charities in the UK.DiscussionPrehospital critical care for OHCA is not universally available in many EMS. In the UK, it is variable and largely funded through public donations to charities. If this study demonstrates benefit from CCTs at an acceptable cost to the public or EMS commissioners, it will provide a rationale to increase funding and service provision. If no clinical benefit is found, the public and charities providing these services can consider concentrating their efforts on other areas of prehospital care.Trial registrationISRCTN registry ID ISRCTN18375201.

Highlights

  • Survival rates from out-of-hospital cardiac arrest (OHCA) remain low, despite remarkable efforts to improve care

  • Aims and objectives This prospective, observational study will describe the effect of Critical care team (CCT) on survival from OHCA, when compared to advanced-life-support (ALS), the current standard of prehospital care in the United Kingdom (UK)

  • The overall aim of this research project is to guide the commissioning of prehospital care for OHCA

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Summary

Methods

All included NHS ambulance trusts dispatch prehospital critical care teams to confirmed or suspected OHCA. To correct for this imbalance, we will match cases of the CCT group with controls of the ALS-trained paramedic group, using propensity score matching This method of controlling for prognostic variables in observational data has been used successfully in OHCA research recently [27, 28]. Prognostic factors for both survival to hospital discharge and CCT dispatch will be covariates They will include age and gender of the patient, the cause and location of OHCA, whether it was witnessed, bystander CPR, ambulance response time, first recorded rhythm and distance from CCT base. We estimate that after application of inclusion and exclusion criteria, we will be able to include 6000 patients, of which approximately 600 will be CCT cases This will allow us to detect an absolute improvement in survival rates of approximately 4.5% with a power of 0.8 and alpha 0.05, assuming one-to-two matching and a survival rate of 7.5% in the control group. Cost analysis is undertaken using the following steps: 1. Define the community for which costs are being calculated

Discussion
Background
Estimate the percentage of time that each agency is involved in EMS
Findings
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