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

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

doi:10.1002/hsr2.78

Cited by 5 publications

(9 citation statements)

References 34 publications

(63 reference statements)

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“…Even with the requirement for more resources per patient with OHCA compared with most other prehospital conditions, only 0.82% of the annual spending was allocated to OHCAs at an estimated cost of £347 per OHCA. This might seem a rather low amount of money to be spent on the immediate care for a life or death situation 13…”

Section: Discussionmentioning

confidence: 99%

“…A patient and public involvement (PPI) group was consulted during the application and planning process of the doctoral research fellowship, which underlies this research. In addition, the PPI groups’ views, as well as other relevant stakeholders’ views, expressed during previous research13 informed the methods of this research. Results will be disseminated to all stakeholders who participated, through an executive summary of this research.…”

Section: Methodsmentioning

confidence: 99%

“…To our knowledge, no economic analysis exists that addresses the question of cost-effectiveness of prehospital critical care for OHCA. In addition, a recent study of stakeholders’ views of prehospital care for OHCA revealed contrasting opinion of whether current NHS funding of prehospital ALS care for OHCA represents an appropriate distribution of limited healthcare resources in the UK 13. Adding to the complexity of cost-effectiveness of prehospital ALS or critical care for OHCA is the fact that the majority of costs occur along the patient care pathway in hospital or postdischarge 14 15…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model

2019

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ObjectivesThis research aimed to answer the following questions: What are the costs of prehospital advanced life support (ALS) and prehospital critical care for out-of-hospital cardiac arrest (OHCA)? What is the cost-effectiveness of prehospital ALS? What improvement in survival rates from OHCA would prehospital critical care need to achieve in order to be cost-effective?SettingA single National Health Service ambulance service and a charity-funded prehospital critical care service in England.ParticipantsThe patient population is adult, non-traumatic OHCA.MethodsWe combined data from previously published research with data provided by a regional ambulance service and air ambulance charity to create a decision tree model, coupled with a Markov model, of costs and outcomes following OHCA. We compared no treatment for OHCA to the current standard of care of prehospital ALS, and prehospital ALS to prehospital critical care. To reflect the uncertainty in the underlying data, we used probabilistic and two-way sensitivity analyses.ResultsCosts of prehospital ALS and prehospital critical care were £347 and £1711 per patient, respectively. When costs and outcomes of prehospital, in-hospital and postdischarge phase of OHCA care were combined, prehospital ALS was estimated to be cost-effective at £11 407/quality-adjusted life year. In order to be cost-effective in addition to ALS, prehospital critical care for OHCA would need to achieve a minimally economically important difference (MEID) in survival to hospital discharge of 3%–5%.ConclusionThis is the first economic analysis to address the question of cost-effectiveness of prehospital critical care following OHCA. While costs of either prehospital ALS and/or critical care per patient with OHCA are relatively low, significant costs are incurred during hospital treatment and after discharge in patients who survive. Knowledge of the MEID for prehospital critical care can guide future research in this field.Trial registration numberISRCTN18375201

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model

2019

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“…Due to the ethical and logistical challenges of randomising the intervention of prehospital critical care, 10 we chose a prospective observational research design. We used propensity score matching to adjust for confounding, including a number of sensitivity analyses.…”

Section: Methodsmentioning

confidence: 99%

“…The dispatch of existing prehospital critical care services should focus on patients with OHCA who might require critical care interventions, patients with a high likelihood of achieving ROSC, and/or where transfer to a cardiac arrest centre is indicated but unlikely to be achievable with the means available to prehospital ALS providers. Other factors to consider are the ethical issues and social acceptability of the provision of prehospital care for patients in OHCA 10.…”

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confidence: 99%

The effect of prehospital critical care on survival following out-of-hospital cardiac arrest: A prospective observational study

2020

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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 1,847 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.

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Drug-free tracheal intubation by specialist paramedics (critical care) in a United Kingdom ambulance service: a service evaluation

Budd¹,

Alexander-Elborough²,

Brandon³

et al. 2021

BMC Emerg Med

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Background Drug-free tracheal intubation has been a common intervention in the context of out-of-hospital cardiac arrest for many years, however its use by paramedics has recently been the subject of much debate. Recent international guidance has recommended that only those achieving high tracheal intubation success should continue to use it. Methods We conducted a retrospective service evaluation of all drug-free tracheal intubation attempts by specialist paramedics (critical care) from South East Coast Ambulance Service NHS Foundation Trust between 1st January and 31st December 2019. Our primary outcome was first-pass success rate, and secondary outcomes were success within two attempts, overall success, Cormack-Lehane grade of view, and use of bougie. Results There were 663 drug-free tracheal intubations and following screening, 605 were reviewed. There was a first-pass success rate of 81.5%, success within two attempts of 96.7%, and an overall success rate of 98.35%. There were ten unsuccessful attempts (1.65%). Bougie use was documented in 83.4% on the first attempt, 93.5% on the second attempt and 100% on the third attempt, Conclusion Specialist paramedics (critical care) are able to deliver drug-free tracheal intubation with good first-pass success and high overall success and are therefore both safe and competent at this intervention.

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

Cited by 5 publications

References 34 publications

Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model

Cost-effectiveness of advanced life support and prehospital critical care for out-of-hospital cardiac arrest in England: a decision analysis model

The effect of prehospital critical care on survival following out-of-hospital cardiac arrest: A prospective observational study

Drug-free tracheal intubation by specialist paramedics (critical care) in a United Kingdom ambulance service: a service evaluation

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