CAN THE FULL RANGE OF PARAMEDIC SKILLS IMPROVE SURVIVAL FROM OUT-OF-HOSPITAL CARDIAC ARRESTS

Objective-To examine the effect of full implementation of advanced ski lls by ambulance personnel on the outcome from out of hospital cardiac arrest. Setting-Patients with cardiac arrest treated at the accident and emergency department of the Royal Infirmary of Edinburgh. Methods- Ah cardiorespiratory arrests occurring in the community were studied o ver a one year period. For patients arresting before the arrival of an ambulance crew, outcome of 92 patients treated by emergency medical t echnicians equipped with defibrillators was compared with that of 155 treated by paramedic crews. The proportions of patients whose arrest w as witnessed by lay persons and those that had bystander cardiopulmona ry resuscitation (CPR) were similar in both groups. Results-There was no difference in the presenting rhythm between the two groups. Eight o f 92 patients (8.7%) treated by technicians survived to discharge comp ared with eight of 155 (5.2%) treated by paramedics (NS). Of those in ventricular fibrillation or pulseless ventricular tachycardia, eight o f 43 (18.6%) in the technician group and seven of 80 (8.8%) in the par amedic group survived to hospital discharge (NS). For patients arresti ng in the presence of an ambulance crew, four of 13 patients treated b y technicians compared with seven of 15 by paramedics survived to hosp ital discharge. Only two patients surviving to hospital discharge rece ived drug treatment before the return of spontaneous circulation. Conc lusions-No improvement in survival was demonstrated with more advanced prehospital care.