Paramedics need regular experience of treating cardiac arrest patients

2nd March 2016

Paramedics who see more cardiac arrest patients successfully resuscitate more of them, a study suggests.

The study in Australia found that helping cardiac arrest patients in the last three years was more important than years of experience as a paramedic. 

The study looked at how successful out-of-hospital CPR was by paramedics in Victoria from 2003 to 2012.

The researchers, led by Kyle Dyson from Monash University, said that attending previous resuscitation attempts was what counted.  Years of experience working as a paramedic was not linked with greater patient survival.

In addition, more experienced paramedics were more likely to withhold CPR—either due to "more confident decision-making or, alternatively, pessimism," the researchers wrote in their article published last month in Circulation: Cardiovascular Quality and Outcomes.

The researchers concluded that how many times a paramedic attends a cardiac arrest "needs to be monitored, and strategies to supplement exposure to cardiac arrest, such as simulation training [and thorough debriefing], should be explored.”

Fewer than 10% of patients who have an out-of-hospital cardiac arrest survive, and timely resuscitation by paramedics is critical, the researchers said. However, paramedics and first responders typically treat few cases, and resuscitation skills decline over time.

During the study, 4151 paramedics were employed, and there were 48,291 out-of-hospital cardiac arrests, with resuscitation attempted in 44% of cases.

On average, paramedics only attended two cardiac arrest patients a year, and one in ten saw none in the seven-year outcome period (2006–2012).

There was a 1% increase in the odds of patient survival for every additional increase in the median attendance by the paramedic.

This is an observational study, and the results may not apply to smaller services in other areas, the researchers concedes.

Nevertheless patient survival deteriorated when paramedics had not treated an out-of-hospital cardiac arrest in the past six months, which is the same time that studies have shown that advanced life-support skills deteriorate.

"This suggests that six-month exposure to either [out-of-hospital cardiac arrest] cases or resuscitation training might be required to prevent skill deterioration and to maximize patient survival," said the researchers.

For more details, see here.

References: Dyson K, Bray JE, Smith K, et al. Paramedic exposure to out-of-hospital cardiac arrest resuscitation is associated with patient survival. Circ Cardiovasc Qual Outcomes 2016.