Volume 14 Issue 4

Prognostic value of lactate in out-of-hospital cardiac arrest: a prospective cohort study

Background: The prognostic role of lactate in out-of-hospital cardiac arrest (OHCA) remains unclear. Aims: To explore serum lactate as a predictor of return of spontaneous circulation in patients experiencing OHCA after arrival at hospital. Methods: This 13-month prospective observational cohort study involved patients aged ≥18 years. Serum lactate levels were measured during cardiopulmonary resuscitation before ROSC. Patients were divided into two groups by lactate level: Group 1, low (≤9.9 mmol/l) and Group 2, high (≥10 mmol/l). Findings: 105 patients were included, 50 in group 1 and 55 group 2. Median lactate were 7.4 mmol/l and 14.2 mmol/l respectively. More patients in group 1 were found with ventricular fibrillation (40% versus 14.5%; <em>P</em>≤0.01), obtained ROSC more quickly (37 minutes 38 seconds versus 39 minutes 13 seconds; <em>P</em>=0.79) and achieved short-term survival (survived &gt;24 hours) (40% versus 23.5%; <em>P</em>=0.32), versus group 2; prediction of survival did not reach statistical significance. Conclusion: Lower lactate levels in OHCA appear to be associated with better short-term outcomes but the cut-off points regarding survival remain unclear.

Air ambulance outcomes of out-of-hospital cardiac arrest seen in the pandemic

Introduction: COVID-19 was declared a global health pandemic in March 2020, and national lockdowns were imposed in an attempt to limit the spread of the virus. Several studies have reported significant increases in the number of out-of-hospital cardiac arrest (OHCA) attendances coupled with a reduction in return of spontaneous circulation (ROSC). This is the first study to report the characteristics and outcomes from OHCA in a UK air ambulance setting. Methods: A retrospective database review of adult OHCA with a medical cause attended by Thames Valley Air Ambulance was undertaken covering two time periods: 1 February 2019 to 31 January 2020; and 1 February 2020 to 31 January 2021. Cases during the pandemic period were screened for COVID-19 symptoms. Descriptive statistics were used to establish the characteristics of COVID-19. The primary outcome of the study was ROSC on arrival at hospital. Results: An overall rise of 6.6% in OHCA was noted between the pre-pandemic and pandemic periods, with a prevalence of COVID-19 of 6.0%. There was a significant increase in termination of resuscitation at scene (42.6% to 54.8%; P&lt;0.001). Overall, ROSC at hospital decreased (37.7% versus 31.1%). Conclusion: This study highlights the impact and implications of a global pandemic on OHCA and an air ambulance system. Poorer overall outcomes were observed during the pandemic period. Further exploration of the effects of COVID-19 on OHCA and air ambulance systems is required.

Use of specialist paramedic dispatch in emergency ambulance control

Optimising patient care through the delivery of specialist resource allocation at the point of injury improves patient outcomes. As identified by the NHS, high-quality call handling and dispatch of the right response, first time, is critical to these outcomes (<xref ref-type="bibr" rid="B10">NHS, 2015</xref>). Aim: This article presents an objective literature review and critical analysis of the evidence base concerning clinical dispatch. This study aims to highlight key differences between the triage and dispatch processes of specialist resources, to establish if the evidence supports the use of one model to manage these resources, and to ascertain best practice. Method: A structured literature review was undertaken and thematic analysis was used to explore the findings of the literature, leading to the establishment of recommendations for best practice in this area. Results: The literature discourages dispatching specialist teams based solely on computer-aided dispatch software codes, and recognises that specialist paramedic dispatchers have a better understanding of the clinical and ethical challenges of appropriately dispatching specialist, finite resources. Conclusion: The literature supports the use of clinicians in dispatching specialist resources to best meet the needs of those patients who are critically ill or injured.

Predicting conveyance to the emergency department for older adults who fall

Background: Falls are frequent in older adults and are associated with high mortality, morbidity and immobility. Many patients can be managed in the community, but some will require conveyance to the emergency department (ED). Aims: This study aims to identify predictive characteristics of conveyance to the ED after a fall. Methods: A cross-sectional study between December 2018 and September 2020 involved patients attended by a falls rapid response service. Eligible patients were aged ≥60 years with mental capacity, had experienced a fall and were living within the relevant geographical area. Findings: 426 patients were enrolled, with a mean age of 82.61 years (SD 8.4; range 60–99 years) and 60.7% were women. Predictive characteristics of conveyance were an injurious fall or pain (OR 8.25; 95% CI (4.89–14.50); <em>P</em>≤0.01) and having been lying for a long time (OR 1.6; 95% CI (1.00–2.56); <em>P</em>=0.04). Conclusion: It is possible to identify predictors of conveyance to the ED; therefore, an undifferentiated approach towards dispatching the falls rapid response service to all older adults who fall is unwarranted.

Imposter syndrome

Mahdiyah Bandali reflects on her experience of imposter syndrome and ideas to tackle it

Barriers and facilitators to out-of-hospital pain management for children

Pain is one of the most common symptoms presented by patients of all ages to ambulance services. While children in pain make up a relatively small proportion of the patients attended by prehospital care services, medical intervention is needed in only 40% of cases. This might go some way to explaining why management of paediatric pain is perceived as poor. Aim: To establish and explore published barriers and facilitators to out-of-hospital pain management for children aged <18 years. Methods: Key search terms were used to search the three databases (CINAHL, MEDLINE and PSYCHInfo) individually and simultaneously. Inclusion and exclusion criteria were applied and 15 papers were identified as meeting the criteria and were subject to data extraction. Results: Three broad themes were identified; organisational factors, patient factors and clinician factors. Conclusion: From considering international systems and aspects of care, it can generally be accepted that the assessment and management of paediatric pain is below what would be expected, and compared with with that for adults, it is sub-optimal. Multiple demographic influences are evident and appear to influence clinician decisions.

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