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Research

Blood gas analysis to aid decisions in non-traumatic out-of-hospital cardiac arrest

02 May 2025
Research
02 May 2025
Volume 17 · Issue 5
paramedics managing a cardiac arrest

Abstract

Background:

Out-of-hospital cardiac arrest (OHCA) is a presentation faced by paramedics where decision-making is complex. Blood gas analysis (BGA) is used by hospital-based clinicians to guide decisions, suggesting its prehospital use could support paramedics.

Aim:

This study aimed to examine the current literature to elucidate whether BGA could support UK-based paramedic decision-making when managing a non-traumatic adult OHCA.

Methods:

Research literature surrounding the topic was sourced via the CINAHL and MEDLINE databases as well as through a grey literature search.

Findings:

Nine articles were reviewed, which showed consistent themes of BGA correlating to prognosis, therapeutic intervention and Utstein factors.

Conclusion:

The current evidence base is consistent in suggesting that BGA would support decision-making if used prehospitally; however, this is mostly not specific to UK paramedic practice. Further understanding would be required for its inclusion to be considered.

NHS ambulance service paramedics attend approximately 30 000 out-of-hospital cardiac arrests (OHCA) in the UK per year where cardiopulmonary resuscitation (CPR) is commenced (Perkins et al, 2015; NHS England, 2017).

Around 70% of OHCA patients require a decision on whether to terminate resuscitation or transport to an emergency department (ED) with ongoing CPR (Yates et al, 2018). Patients who are transported to hospital with ongoing CPR have <2% chance of survival to discharge and a mortality rate of >90% shortly after arrival (Schmidbauer et al, 2021). This indicates paramedics transport a significant number of OHCA patients to hospital unwarrantedly. UK OHCA survival to discharge is 7–8%, which is poor compared to other developed countries (Phillips, 2018).

Although this can be attributed to bystander performance, paramedic-led management of OHCA could also be improved to increase survival (Resuscitation Council UK (RCUK) et al, 2015; Fisher, 2020).

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Prehospital blood gas analysis
Paramedic decision-making
Out-of-hospital cardiac arrest