Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest

Abstract

Paramedics can provide advanced life support (ALS) for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of emergency medical technician (EMT) configuration on their outcomes remains debated. A three-year cohort study consisted of non-traumatic OHCA adults transported by ALS teams was retrospectively conducted in Tainan City using an Utstein-style population database. The EMT-paramedic (EMT-P) ratio was defined as the EMT-P proportion out of all on-scene EMTs. Among the 1357 eligible cases, the median (interquartile range) number of on-scene EMTs and the EMT-P ratio were 2 (2–2) persons and 50% (50–100%), respectively. The multivariate analysis identified five independent predictors of sustained return of spontaneous circulation (ROSC): younger adults, witnessed cardiac arrest, prehospital ROSC, prehospital defibrillation, and comorbid diabetes mellitus. After adjustment, every 10% increase in the EMT-P ratio was on average associated with an 8% increased chance (adjusted odds ratio [aOR], 1.08; p < 0.01) of sustained ROSC and a 12% increase change (aOR, 1.12; p = 0.048) of favorable neurologic status at discharge. However, increased number of on-scene EMTs was not linked to better outcomes. For nontraumatic OHCA adults, an increase in the on-scene EMT-P ratio resulted in a higher proportion of improved patient outcomes.

A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes

“…As seen in Figure 1 , a total of eight studies were included in this systematic review ref. [ 12 , 13 , 14 , 15 , 16 , 20 , 21 , 22 ]. Most of these were retrospective cohort studies.…”

“…Most of these were retrospective cohort studies. One study [ 13 ] was excluded from the final meta-analysis as it lacked a control group for comparison. Unlike the other studies, in the study by Fang et al, the authors calculated ORs based on a comparison of different crew numbers and the EMT–paramedic ratio was treated as a continuous variable: 25.0–33.3%, 50%, 66.7–75.0% and 100% [ 13 ].…”

“…In addition to numbers, the skill level of the EMS team is also an important consideration. As highlighted by studies from Taiwan [ 13 , 21 ], the EMT–paramedic ratio but not the number of EMTs is positively associated with survival [ 21 ]. This observation was corroborated by a more recent Taiwanese study [ 13 ]; the training hours required for EMT paramedic accreditation in Taiwan is 1280 h, which is more than four times that of the EMT intermediate accreditation.…”

“…Multiple approaches as to what defines high quality have been used. This includes high-performance CPR (HP CPR), multi-tiered response (MTR) and minimally interrupted cardiac resuscitation (MICR) [ 12 , 13 , 14 , 15 , 16 ]. The approaches elaborated in these studies are united in their common goal to provide quality resuscitative efforts by focusing on responder skills and intra-professional role coordination.…”

Blood Cultures and Broad-Spectrum Antimicrobials are Essential for Patients with Out-of-Hospital Cardiac Arrest

“…All resuscitations were directed by boardcerti ed ED physicians and nurses following the contemporary guidelines of advanced cardiac life support (ACLS). For patient experiencing OHCA, their information prior to ED arrival was captured from an Utstein-style population database, a prospective registry database, in southern Taiwan, and partial information in this database has been published [13]. The study was approved by the institutional review boards of three study hospital and the requirement of informed consent was waived.…”