References
Prehospital neuromuscular blockade post OHCA: UK's first paramedic-delivered protocol
Abstract
Background:
Since 2016, critical care paramedics from the South East Coast Ambulance Service have offered neuromuscular blockade to patients for ventilatory/airway control after cardiac arrest.
Aims:
To examine the first cases of paramedic-delivered neuromuscular blockade, and evaluate the prevalence of its use and safety.
Methods:
Retrospective service evaluation of patients receiving post-arrest paralysis during the study period from 1 April 2016 until 31 July 2017.
Findings:
The study included 127 patients. The mean age of administration was 63 years, mean weight was 80 kg (SD: 19 kg), dose was 1 mg/kg and median time from rocuronium administration to hospital was 32 minutes (IQR 20–43 minutes). Three patients (2.3%) experienced a minor adverse incident. There were no major airway complications, nor other significant adverse incidents. Thirty-seven patients (31%) survived to discharge.
Conclusion:
From this patient group, paramedic-administered rocuronium in intubated patients who have experienced a cardiac arrest and a return of spontaneous circulation appears to be safe, but further interventional research is required to determine whether this improves patient outcomes.
Between 1 April 2017 and 31 March 2018, ambulance services attempted to resuscitate 32 099 people in England alone (NHS England, 2018), achieving a return of spontaneous circulation (ROSC) in 9846 (30%) patients that was sustained to hospital. Work is continuously being undertaken to improve out-of-hospital cardiac arrest (OHCA) survival. Patients who have experienced an OHCA with subsequent ROSC can present with a complex array of symptoms, and are at particular risk of respiratory and cardiovascular compromise.
The optimal prehospital care strategies for patients experiencing an OHCA are not yet fully understood (Adrie et al, 2004; Neumar et al, 2008). Of patients who receive advanced airway management during resuscitation, only a minority will regain sufficient consciousness in the prehospital phase to allow step down to basic airway management. With an increasing emphasis on primary transfer of OHCA patients to regional specialist centres, both urban and rural paramedics could find themselves in a position where they are unable to ventilate or oxygenate their patient effectively, or prevent aspiration and potentially lose airway patency in a patient still highly reliant on ventilatory support or airway control.
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