Background:

Annually English NHS Ambulance Services treat over 30,000 out-of-hospital cardiac arrest (OHCA) patients. Upon arrival of the ambulance to the scene of the OHCA treatment shifts from interventions such as cardiopulmonary resuscitation (CPR) and defibrillation which can be delivered by a bystander, to include interventions that require the specialised skills and knowledge of paramedics. These advanced life support (ALS) skills include drug therapy and management of the airway. Adequate ventilation and airway management are integral parts of OHCA management and range from using a bag-valve-mask ventilation to advanced strategies such as supraglottic airway (SGA) devices and endotracheal intubation (ETI). Over 80% of OHCA patients receive either an ETI of SGA device. However, because the process of intubating a patient often necessitates the pausing of CPR and success rates may be sub-optimal there was uncertainty regarding the optimal airway management strategy for OHCA. Following evidence from major clinical trials and observational studies, and international organisations, recommendations were made that only specialist paramedics should perform ETI. Nevertheless, the introduction of these guidelines was not universal, and there is a need for research to understand the variation in practice and potential implications on patient outcome.

Policy and Practice Partners:

Prof Jerry Nolan, CTU, UoW

Dr Alison Walker, West Midlands Ambulance Service University NHS Foundation Trust

Dr Jasmeet Soar, North Bristol NHS Trust

Prof Charles Deakin, University of Southampton

Prof Rachel Fothergill, London Ambulance Service NHS Trust

Co-Funding partners:

Resuscitation Council UK

Aims and Objectives:

The project aims to evaluate the impact of endotracheal intubation (ETI) withdrawal from UK paramedic services on the processes and patient outcomes following adult out-of-hospital cardiac arrest (OHCA). The specific project objectives are:

1. Identify variability in UK ambulance services' policies regarding the performance of ETI by paramedics.

2. Describe changes in processes and patient outcomes for adult OHCA and airway management.

3. Identify variability in airway management use across UK ambulance services.

4. Evaluate the impact of changing airway practices on patient outcomes.

Methods:

This is a retrospective analysis of data from the OHCA Outcomes registry, supplemented by organisational policy data on paramedics' use of ETI for adult OHCA. The primary outcome is survival to hospital discharge; with secondary outcomes of return of spontaneous circulation (ROSC) at any time, ROSC at hospital handover, ETI and supraglottic airway use frequency. We will look at the change in rates of the outcomes in three time periods:

1. The period before any withdrawal or limitation of ETI.

2. The period following publication of the Airways-2 trial.

3. The period following any withdrawal or limitation of ETI (analysis at ambulance service level).

For each period, we will describe patients' baseline characteristics and outcomes. We will compare outcomes using a logistic regression model with adjustments for baseline characteristics and ambulance service. We will report differences in outcomes in terms of the odds ratio and 95% confidence interval

Main Results:

Not available yet

Conclusions:

Not available yet

Implications for Implementation:

There is a need for the research to understand the variation in practice and potential implications on patient outcome.