Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest

Vopelius-Feldt, Johannes von; Brandling, Janet; Benger, Jonathan

doi:10.1016/j.resuscitation.2017.02.018

Cited by 25 publications

(30 citation statements)

References 36 publications

(41 reference statements)

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“…Helicopter Emergency Medical Services (HEMS) play an important role in prehospital care of the critically ill in many Emergency Medical Services (EMS) around the world. However, little is known about when and where the utilization of this expensive resource is beneficial [1][2][3]. Organization of HEMS varies considerably between countries and states.…”

Section: Introductionmentioning

confidence: 99%

The first seven years of nationally organized helicopter emergency medical services in Finland – the data from quality registry

Saviluoto

Björkman

Olkinuora³

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Helicopter Emergency Medical Services (HEMS) play an important role in prehospital care of the critically ill. Differences in funding, crew composition, dispatch criteria and mission profile make comparison between systems challenging. Several systems incorporate databases for quality control, performance evaluation and scientific purposes. FinnHEMS database was incorporated for such purposes following the national organization of HEMS in Finland 2012. The aims of this study are to describe information recorded in the database, data collection, and operational characteristics of Finnish HEMS during 2012-2018. Methods: All dispatches of the six Finnish HEMS units recorded in the national database from 2012 to 2018 were included in this observational registry study. Five of the units are physician staffed, and all are on call 24/7. The database follows a template for uniform reporting in physician staffed pre-hospital services, exceeding the recommended variables of relevant guidelines. Results: The study included 100,482 dispatches, resulting in 33,844 (34%) patient contacts. Variables were recorded with little or no missing data. A total of 16,045 patients (16%) were escorted by HEMS to hospital, of which 2239 (2%) by helicopter. Of encountered patients 4195 (4%) were declared deceased on scene. The number of denied or cancelled dispatches was 66,638 (66%). The majority of patients were male (21,185, 63%), and the median age was 57.7 years. The median American Society of Anesthesiologists Physical Scale classification was 2 and Eastern Cooperative Oncology Group performance class 0. The most common reason for response was trauma representing 26% (8897) of the patients, followed by out-of-hospital cardiac arrest 20% (6900), acute neurological reason excluding stroke 13% (4366) and intoxication and related psychiatric conditions 10% (3318). Blunt trauma (86%, 7653) predominated in the trauma classification.

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Section: Introductionmentioning

confidence: 99%

The first seven years of nationally organized helicopter emergency medical services in Finland – the data from quality registry

Saviluoto

Björkman

Olkinuora³

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…The mechanisms by which prehospital critical care might improve outcomes in OHCA are the experience of the providers, advanced interventions (such as prehospital anaesthesia), or the ability to transfer patients over greater distances to cardiac arrest centres, using equipment and interventions not available to ALS paramedics . However, there is currently no clear evidence that prehospital critical care improves survival following OHCA when compared to ALS care . Prehospital critical care is funded through a complex and variable combination of charity support (particularly if associated with an air ambulance) and National Health Service (NHS) ambulance service funding .…”

Section: Introductionmentioning

confidence: 99%

“…4 In an effort to improve outcomes, some regions in the UK dispatch prehospital critical care teams to OHCAs, in addition to the standard of ALS paramedic care. 5 Prehospital critical care can be described as a bundle of interventions beyond the remit of standard emergency medical service (EMS) treatment, delivered by a group of specialist prehospital health care providers. 6 The mechanisms by which prehospital critical care might improve outcomes in OHCA are the experience of the providers, advanced interventions (such as prehospital anaesthesia), or the ability to transfer patients over greater distances to cardiac arrest centres, using equipment and interventions not available to ALS paramedics.…”

Section: Introductionmentioning

confidence: 99%

“…6 However, there is currently no clear evidence that prehospital critical care improves survival following OHCA when compared to ALS care. 5 Prehospital critical care is funded through a complex and variable combination of charity support (particularly if associated with an air ambulance) and National Health Service (NHS) ambulance service funding. 7,8 Researching potential benefits from prehospital critical care for OHCA is important to guide further funding, but is challenging because of the complexity of prehospital critical care itself and the limitations of undertaking prehospital research in OHCA.…”

Section: Introductionmentioning

confidence: 99%

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Variations in stakeholders' priorities and views on randomisation and funding decisions in out‐of‐hospital cardiac arrest: An exploratory study

Vopelius-Feldt

Brandling

Benger

2018

Health Science Reports

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Background and aimsPrehospital critical care for out‐of‐hospital cardiac arrest (OHCA) is a complex and largely unproven intervention. During research to examine this intervention, we noted significant differences in stakeholders' views about research, randomisation, and the funding of prehospital critical care for OHCA. We aimed to answer the following questions: What are stakeholders' priorities for prehospital research? What are stakeholders' views on randomisation of prehospital critical care? How do stakeholders consider allocation of resources in prehospital care?MethodsWe undertook an explanatory qualitative framework analysis of interviews and focus group with 5 key stakeholder groups: patients and public, air ambulance charities, ambulance service commissioners, prehospital researchers, and prehospital critical care providers.ResultsWe undertook 3 focus group discussions with a total of 23 participants and 8 interviews with a total of 9 participants. Despite sharing a common appreciation of the concepts of scientific enquiry, fairness, and beneficence, the 5 relevant stakeholder groups displayed divergent views of research and funding strategies regarding the intervention of prehospital critical care for the condition of OHCA. The reasons for this divergence could largely be explained through the different personal experiences and situational contexts of each stakeholder group. Many aspects of the strategies suggested by the stakeholder groups only partially aligned with principles of traditional evidence‐based medicine, but were held with strong conviction.DiscussionAnalysis of the views of 5 stakeholder groups regarding research and the funding of prehospital critical care for OHCA revealed shared values but a variety of different strategies to achieve these. This knowledge can help researchers in similar fields in the planning and presentation of their research, to maximise impact on decision making.

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“…ALS might put patients with trauma at risk as it increases the time spent on-scene; however, providing ALS can also be used to resuscitate patients with trauma on-scene. In 2017, von Vopelius-Feldt and colleagues6 reported in their systematic review that prehospital critical care had a limited effect; none of the included studies showed obvious benefits for non-trauma CPA patients. This implies that it is important to treat patients, and particularly patients with trauma, at the hospital rather than in prehospital settings.…”

Section: Introductionmentioning

confidence: 99%

Effects of advanced life support versus basic life support on the mortality rates of patients with trauma in prehospital settings: a study protocol for a systematic review and meta-analysis

et al. 2017

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IntroductionAdvanced life support (ALS) is thought to be associated with improved survival in prehospital trauma care when compared with basic life support (BLS). However, evidence on the benefits of prehospital ALS for patients with trauma is controversial. Therefore, we aim to clarify if ALS improves mortality in patients with trauma when compared with BLS by conducting a systematic review and meta-analysis of the recent literature.Methods and analysisWe will perform searches in PubMed, Embase and the Cochrane Central Register of Controlled Trials for published observational studies, controlled before-and-after studies, randomised controlled trials and other controlled trials conducted in humans and published until March 2017. We will screen search results, assess study selection, extract data and assess the risk of bias in duplicate; disagreements will be resolved through discussions. Data from clinically homogeneous studies will be pooled using a random-effects meta-analysis, heterogeneity of effects will be assessed using the χ2 test of homogeneity, and any observed heterogeneity will be quantified using the I2 statistic. Last, the Grading of Recommendations Assessment, Development and Evaluation approach will be used to rate the quality of the evidence.Ethics and disseminationOur study does not require ethical approval as it is based on findings of previously published articles. Results will be disseminated through publication in a peer-reviewed journal, presentations at relevant conferences and publications for patient information.Trial registration numberPROSPERO (International Prospective Register of Systematic Reviews) registration number CRD42017054389.

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Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest

Abstract: Current evidence to support prehospital critical care for OHCA is limited by the logistic difficulties of undertaking high quality research in this area. Further research needs an appropriate sample size with adjustments for confounding factors in observational research design.

Cited by 25 publications

References 36 publications

The first seven years of nationally organized helicopter emergency medical services in Finland – the data from quality registry

The first seven years of nationally organized helicopter emergency medical services in Finland – the data from quality registry

Variations in stakeholders' priorities and views on randomisation and funding decisions in out‐of‐hospital cardiac arrest: An exploratory study

Effects of advanced life support versus basic life support on the mortality rates of patients with trauma in prehospital settings: a study protocol for a systematic review and meta-analysis

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