Does Experience Matter? Paramedic Cardiac Resuscitation Experience Effect on Out-of-Hospital Cardiac Arrest Outcomes

Abstract

This study demonstrated that more experienced paramedics had a statistically significant increase in achieving sustained ROSC when they were functioning in a lead role compared to less experienced paramedics. We found no other clinically significant patient outcomes related to the provider's experience.

Education, Implementation, and Teams

“…This study found higher exposure of the treating paramedic was associated with increased ROSC, compared with the reference group with fewer than 15 exposures and the group with 15 exposures or more (adjusted OR, 1.22; 95% CI, 1.11À1.36). The other non-RCT 196 also found an unadjusted association between 10 exposures or more for the lead paramedic over a 1-year period and achievement of ROSC (OR, 1.30; 95% CI, 1.01À1.69).…”

“…For the critical outcome of survival with favorable neurological outcome at discharge/ 30 days, we identified very low-certainty evidence (downgraded for risk of bias and imprecision) from 1 non-RCT. 196 This study examined exposure for EMS-physicians and reported unadjusted data with insufficient numbers of events to be confident in the direction of the outcome estimates.…”

“…For the critical outcome of survival to discharge/30 days, we identified very low-certainty evidence (downgraded for risk of bias and imprecision) from 3 non-RCTs. 191,192,196 The largest and highestquality non-RCT 192 reported adjusted outcomes and examined the whole resuscitating teams' exposure in the preceding 3 years. This study found that higher team exposure in the preceding 3 years was associated with increased survival to discharge: comparing the reference group with 6 exposures or fewer, with a group having more than 6 to 11 exposures (adjusted OR, 1.26; 95% CI, 1.04À1.54), group with 11 to 17 exposures (adjusted OR, 1.29; 95% CI, 1.04À1.59), and a third group having more than 17 exposures (adjusted OR, 1.50; 95% CI, 1.22À1.86).…”

“…For the critical outcome of event survival, we identified very lowcertainty evidence (downgraded for risk of bias and imprecision) from 2 non-RCTs. 191,196 These 2 studies reported unadjusted outcomes and used the average exposure of team leaders to resuscitation over 1-196 and 3-year study periods. 191 These studies found no association between exposure to resuscitation, at cutoffs of 5 exposures over 3 years for EMS-physicians 191 or 10 exposures over 1 year for the lead paramedic, 196 and unadjusted event survival.…”

“…For the critical outcome of ROSC, we identified very low-certainty evidence (downgraded for risk of bias) from 2 non-RCTs. 195,196 The largest non-RCT 195 reported adjusted outcomes and examined the primary treating paramedic's exposure in the preceding 5 years. This study found higher exposure of the treating paramedic was associated with increased ROSC, compared with the reference group with fewer than 15 exposures and the group with 15 exposures or more (adjusted OR, 1.22; 95% CI, 1.11À1.36).…”