Paramedic Exposure to Out-of-Hospital Cardiac Arrest Resuscitation Is Associated With Patient Survival

Kylie Dyson; Janet E Bray; Karen Smith; Stephen Bernard; Lahn Straney; Judith Finn

doi:10.1161/CIRCOUTCOMES.115.002317

Paramedic Exposure to Out-of-Hospital Cardiac Arrest Resuscitation Is Associated With Patient Survival

Circ Cardiovasc Qual Outcomes. 2016 Mar;9(2):154-60. doi: 10.1161/CIRCOUTCOMES.115.002317. Epub 2016 Jan 26.

Authors

Kylie Dyson¹, Janet E Bray², Karen Smith², Stephen Bernard², Lahn Straney², Judith Finn²

Affiliations

¹ From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (K.D., J.E.B., K.S., S.B., L.S., J.F.); Clinical and Community Services, Ambulance Victoria, Melbourne, Australia (K.D., S.B.); Department of Research and Evaluation, Ambulance Victoria, Melbourne, Australia (K.S.); Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia (K.S., J.F.); Emergency and Trauma Centre, Alfred Hospital, Melbourne, Australia (J.E.B.) Intensive Care Department, Alfred Hospital, Melbourne, Australia (S.B.); Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia (J.E.B., J.F.). kylie.dyson@monash.edu.
² From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (K.D., J.E.B., K.S., S.B., L.S., J.F.); Clinical and Community Services, Ambulance Victoria, Melbourne, Australia (K.D., S.B.); Department of Research and Evaluation, Ambulance Victoria, Melbourne, Australia (K.S.); Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia (K.S., J.F.); Emergency and Trauma Centre, Alfred Hospital, Melbourne, Australia (J.E.B.) Intensive Care Department, Alfred Hospital, Melbourne, Australia (S.B.); Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia (J.E.B., J.F.).

PMID: 26812932
DOI: 10.1161/CIRCOUTCOMES.115.002317

Abstract

Background: Although out-of-hospital cardiac arrest (OHCA) is a major public health problem, individual paramedics are rarely exposed to these cases. In this study, we examined whether previous paramedic exposure to OHCA resuscitation is associated with patient survival.

Methods and results: For the period 2003 to 2012, we linked data from the Victorian Ambulance Cardiac Arrest Registry to Ambulance Victoria's employment data set. We defined exposure as the number of times a paramedic attended an OHCA where resuscitation was attempted in the 3 years preceding each case. Using a multivariable model adjusting for known predictors of survival, we measured the association between paramedic OHCA exposure and patient survival to hospital discharge. During the study period, there were 4151 paramedics employed and 48 291 OHCAs (44% with resuscitation attempted). The median exposure of all paramedics was 2 (interquartile range 1-3) OHCAs/year. Eleven percent of paramedics were not exposed to any OHCA cases. Increased paramedic exposure was associated with reduced odds of attempted resuscitation (P<0.001). In the 3 years preceding each OHCA where resuscitation was attempted, the median exposure of the treating paramedics was 11 (interquartile range 6-17) OHCAs. Compared with patients treated by paramedics with a median of ≤6 exposures during the previous 3 years (7% survival), the odds of survival were higher for patients treated by paramedics with >6 to 11 (12%, adjusted odds ratio 1.26, 95% confidence interval 1.04-1.54), >11 to 17 (14%, adjusted odds ratio 1.29, 95% confidence interval 1.04-1.59), and >17 exposures (17%, adjusted odds ratio 1.50, 95% confidence interval 1.22-1.86). Paramedic years of experience were not associated with survival.

Conclusions: Patient survival after OHCA significantly increases with the number of OHCAs that paramedics have previously treated.

Keywords: emergency medical services; employment; heart arrest; resuscitation; survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Clinical Competence*
Emergency Medical Technicians*
Female
Hospital Mortality
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Out-of-Hospital Cardiac Arrest / diagnosis
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / therapy*
Patient Discharge
Registries
Resuscitation*
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Victoria