Volume 14 Issue 9

Prehospital practitioner awareness and experience of CPR-induced consciousness

Background: Cardiopulmonary resuscitation-induced consciousness (CPRIC) is an important but under-researched area. CPRIC in Irish emergency services has never been examined and this study aimed to explore the experiences of prehospital practitioners. Methods: This study includes qualitative and quantitative elements, using an online anonymous survey followed by a confidential, one-to-one, semi-structured interview with emergency medical technicians, paramedics and advanced paramedics. Results: Of the respondents surveyed, 93% had been involved in the care of at least one case of out-of-hospital cardiac arrest (OHCA); 36% had managed 6–10 OHCAs within the previous 12 months. Three-quarters (75%) were aware of CPRIC and 57% reported that they had witnessed at least one episode of this. CPRIC incidents were characterised by a range of clinical features, which sometimes interrupted care provision and were managed using wide-ranging and non-standardised responses including drug therapy. Both high-quality manual and mechanical CPR were linked to CPRIC. The rate of reported return of spontaneous circulation (63%) was significantly higher than that in Irish national data for OHCA. Seven volunteers participated in confidential sem-istructured interviews. Themes identified included the impact on resuscitation, unfamiliarity with CPRIC manifestations, how CPRIC affected practitioners and educational needs. Practitioners experienced distress because of this phenomenon. All highlighted their desire to have CPRIC addressed by clinical practice guidelines.

Diagnostic ability of a computer algorithm to identify prehospital STEMI

Background: Acute myocardial infarction (AMI) accounts for 43% of deaths related to ischaemic heart disease, with ST-segment elevation myocardial infarction (STEMI) accounting for 25%–40% of all AMI presentations. Given the impact of these diseases, there is a strong prehospital focus on early identification, treatment and transport of patients with acute coronary syndrome. The main aim of the STEMI system of care is to reduce the time to reperfusion of the myocardium, thereby improving morbidity and mortality rates. Therefore, the identification of STEMI by paramedics can have a dramatic effect on patients' long-term health outcomes. Ambulance Victoria paramedics play a crucial role in the care provided to AMI patients across the state, with the assistance of a computer-automated interpretation of 12-lead electrocardiograms (ECGs) to aid STEMI identification. Objectives: This study's objective is to analyse the diagnostic capability of the computer-automated interpretation to diagnose STEMI in the out-of-hospital setting. Methods: Quantitative data from January 2018 to December 2019 was sourced from the Victorian Ambulance STEMI Quality Initiative. These data were periodically matched with hospital outcome and diagnosis data from the Victorian Cardiac Outcomes Registry to compare provisional paramedic diagnoses with the final hospital diagnoses. Results: Of the 5269 cases of suspected STEMI, 765 (14.5%) could be matched with outcome data. Of these 765 cases, 88.9% were correctly identified as STEMI. The remaining 10% were categorised as either non-STEMI or unstable angina. No data were available for 1.1%. Conclusions: The diagnostic capability of the Zoll Inovise 12L interpretive algorithm to diagnose STEMI in the out-of-hospital setting appears safe and feasible. However, because of limited data matching paramedic findings with patient outcomes in hospital, no hard conclusions can be drawn. Furthermore, there is no way to ascertain how many false positives the Zoll monitor is interpreting. Further investigation is required to assess the true diagnostic capability of the Zoll Inovise 12L interpretive algorithm.

Gamma-hydroxybutyrate (GHB): a review for the prehospital clinician

Background: Gamma-hydroxybutyrate (GHB) is a depressant of the central nervous system with euphoric effects. It is being increasingly used recreationally in the UK, despite associated morbidity and mortality. Because evidence is lacking, health professionals remain unsure as to the optimum management of GHB acute toxicity. Methods: A literature review was undertaken on GHB pharmacology and the emergency management of its acute toxicity. Findings: GHB is inexpensive and readily available over the internet. Treatment of GHB acute toxicity is supportive. Clinicians should pay attention to the airway as emesis is common. Mechanical ventilation is required in a minority of cases. Polydrug use is common and worsens prognosis. Conclusion: GHB is an inexpensive and readily available drug, and acute toxicity can be difficult to identify and treat. GHB acute toxicity is generally treated conservatively. Further research is needed to ascertain the indications for and the benefits and risks of intubating patients with GHB acute toxicity.

Keep up to date with Journal of Paramedic Practice!

Sign up to Journal of Paramedic Practice’s regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month.