Adrenaline and vasopressin for cardiac arrest.

Background: Adrenaline and vasopressin are widely used to treat people with cardiac arrest, but there is uncertainty about the safety, effectiveness and the optimal dose.

Objectives: To determine whether adrenaline or vasopressin, or both, administered during cardiac arrest, afford any survival benefit.

Search Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and DARE from their inception to 8 May 2018, and the International Liaison Committee on Resuscitation 2015 Advanced Life Support Consensus on Science and Treatment Recommendations.

Epidemiology of trauma patients attended by ambulance paramedics in Perth, Western Australia.

Objective: The aim of the study was to describe the epidemiology of trauma in adult patients attended by ambulance paramedics in Perth, Western Australia.

Methods: A retrospective cohort study of trauma patients aged ≥16 years attended by St John Ambulance Western Australia (SJA-WA) paramedics in greater metropolitan Perth between 2013 and 2016 using the SJA-WA database and WA death data. Incidence and 30 day mortality rates were calculated.

Direct transport to a PCI-capable hospital is associated with improved survival after adult out-of-hospital cardiac arrest of medical aetiology.

Aim: To compare survival outcomes of adults with out-of-hospital cardiac arrest (OHCA) of medical aetiology directly transported to a percutaneous-coronary-intervention capable (PCI-capable) hospital (direct transport) with patients transferred to a PCI-capable hospital via another hospital without PCI services available (indirect transport) by emergency medical services (EMS).

Methods: This retrospective cohort study used the St John Ambulance Western Australia OHCA Database and medical chart review. We included OHCA patients (≥18 years) admitted to any one of five PCI-capable hospitals in Perth between January 2012 and December 2015.

'She's sort of breathing': What linguistic factors determine call-taker recognition of agonal breathing in emergency calls for cardiac arrest?

Background: In emergency ambulance calls, agonal breathing remains a barrier to the recognition of out-of-hospital cardiac arrest (OHCA), initiation of cardiopulmonary resuscitation, and rapid dispatch. We aimed to explore whether the language used by callers to describe breathing had an impact on call-taker recognition of agonal breathing and hence cardiac arrest.

Methods: We analysed 176 calls of paramedic-confirmed OHCA, stratified by recognition of OHCA (89 cases recognised, 87 cases not recognised).

The linguistic and interactional factors impacting recognition and dispatch in emergency calls for out-of-hospital cardiac arrest: a mixed-method linguistic analysis study protocol.

Introduction: Emergency telephone calls placed by bystanders are crucial to the recognition of out-of-hospital cardiac arrest (OHCA), fast ambulance dispatch and initiation of early basic life support. Clear and efficient communication between caller and call-taker is essential to this time-critical emergency, yet few studies have investigated the impact that linguistic factors may have on the nature of the interaction and the resulting trajectory of the call. This research aims to provide a better understanding of communication factors impacting on the accuracy and timeliness of ambulance dispatch.

'Tell me exactly what's happened': When linguistic choices affect the efficiency of emergency calls for cardiac arrest.

Background: Clear and efficient communication between emergency caller and call-taker is crucial to timely ambulance dispatch. We aimed to explore the impact of linguistic variation in the delivery of the prompt "okay, tell me exactly what happened" on the way callers describe the emergency in the Medical Priority Dispatch System.

Methods: We analysed 188 emergency calls for cases of paramedic-confirmed out-of-hospital cardiac arrest.

A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest.

Introduction: Arterial carbon dioxide tension (PaCO) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO makes physiological sense and is recommended as a therapeutic target after CA, but few studies have examined the association between PaCO and patient outcomes. This systematic review and meta-analysis aimed to assess the effect of a low or high PaCO on patient outcomes after CA.

Which patients should be transported to the emergency department? A perpetual prehospital dilemma.

Objective: To examine the ability of paramedics to identify patients who could be managed in the community and to identify predictors that could be used to accurately identify patients who should be transported to EDs.

Methods: Lower acuity patients who were assessed by paramedics in the Perth metropolitan area in 2013 were studied. Paramedics prospectively indicated on the patient care record if they considered that the patient could be treated in the community.

Association between ambulance dispatch priority and patient condition.

Objective: To compare chief complaints of the Medical Priority Dispatch System in terms of the match between dispatch priority and patient condition.

Methods: This was a retrospective whole-of-population study of emergency ambulance dispatch in Perth, Western Australia, 1 January 2014 to 30 June 2015. Dispatch priority was categorised as either Priority 1 (high priority), or Priority 2 or 3.

Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline: The RINSE Trial (Rapid Infusion of Cold Normal Saline).

Background: Patients successfully resuscitated by paramedics from out-of-hospital cardiac arrest often have severe neurologic injury. Laboratory and observational clinical reports have suggested that induction of therapeutic hypothermia during cardiopulmonary resuscitation (CPR) may improve neurologic outcomes. One technique for induction of mild therapeutic hypothermia during CPR is a rapid infusion of large-volume cold crystalloid fluid.

A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study.

Background: This cohort study compared the prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill.

Methods: The relationships between SIG, lactate, anion gap (AG), anion gap albumin-corrected (AG-corrected), base excess or strong ion difference-effective (SIDe), all obtained within the first hour of intensive care unit (ICU) admission, and the hospital mortality of 6878 patients were analysed. The prognostic significance of each acid-base marker, both alone and in combination with the Admission Mortality Prediction Model (MPM0 III) predicted mortality, were assessed by the area under the receiver operating characteristic curve (AUROC).

Paramedic Checklists do not Accurately Identify Post-ictal or Hypoglycaemic Patients Suitable for Discharge at the Scene.

Objectives: The objective of this study was to assess the accuracy and safety of two pre-defined checklists to identify prehospital post-ictal or hypoglycemic patients who could be discharged at the scene.

Methods: A retrospective cohort study of lower acuity, adult patients attended by paramedics in 2013, and who were either post-ictal or hypoglycemic, was conducted. Two self-care pathway assessment checklists (one each for post-ictal and hypoglycemia) designed as clinical decision tools for paramedics to identify patients suitable for discharge at the scene were used.

Use of serum lactate levels to predict survival for patients with out-of-hospital cardiac arrest: A cohort study.

Objectives: We examined the association of serum lactate levels and early lactate clearance with survival to hospital discharge for patients suffering an out-of-hospital cardiac arrest (OHCA).

Methods: A retrospective cohort analysis was performed of patients with OHCA transported by ambulance to two adult tertiary hospitals in Perth, Western Australia. Exclusion criteria were traumatic cardiac arrest, return of spontaneous circulation prior to the arrival of the ambulance, age less than 18 years and no serum lactate levels recorded.

The ability of early warning scores (EWS) to detect critical illness in the prehospital setting: A systematic review.

Aim: To examine whether early warning scores (EWS) can accurately predict critical illness in the prehospital setting and affect patient outcomes.

Methods: We searched bibliographic databases for comparative studies that examined prehospital EWS for patients transported by ambulance in the prehospital setting. The ability of the different EWS, including pre-alert protocols and physiological-based EWS, to predict critical illness (sensitivity, odds ratio [OR], area under receiver operating characteristic [AUROC] curves) and hospital mortality was summarised.

Is it Appropriate for Patients to be Discharged at the Scene by Paramedics?

Background: Outcomes of patients who are discharged at the scene by paramedics are not fully understood.

Objective: We aimed to describe the risk of re-presentation and/or death in prehospital patients discharged at the scene.

Methods: We conducted a retrospective cohort study using linked ambulance, emergency department (ED), and death data.

Using patient admission characteristics alone to predict mortality of critically ill patients: A comparison of 3 prognostic scores.

Purpose: This study compared the performance of 3 admission prognostic scores in predicting hospital mortality.

Materials And Methods: Patient admission characteristics and hospital outcome of 9549 patients were recorded prospectively. The discrimination and calibration of the predicted risks of death derived from the Simplified Acute Physiology Score (SAPS III), Admission Mortality Prediction Model (MPM0 III), and admission Acute Physiology and Chronic Health Evaluation (APACHE) II were assessed by the area under the receiver operating characteristic curve and a calibration plot, respectively.

Trends in traumatic out-of-hospital cardiac arrest in Perth, Western Australia from 1997 to 2014.

Aim: This study aims to describe and compare traumatic and medical out-of-hospital cardiac arrest (OHCA) occurring in Perth, Western Australia, between 1997 and 2014.

Methods: The St John Ambulance Western Australia (SJA-WA) OHCA Database was used to identify all adult (≥ 16 years) cases. We calculated annual crude and age-sex standardised incidence rates (ASIRs) for traumatic and medical OHCA and investigated trends over time.

Challenges during long-term follow-up of ICU patients with and without chronic disease.

Introduction: Reflecting on researchers' experiences during follow-up of patients enrolled in research may lead to improved understanding of the challenges faced in maintaining contact when patients leave hospital.

Aims: (1) Describe the challenges researchers face when following-up patients who survive ICU. (2) Identify issues that influenced our ability to follow-up patients.

The effect of presenting symptoms and patient characteristics on prehospital delay in MI patients presenting to emergency department by ambulance: a cohort study.

Introduction: There is little recent information about prehospital delay time for Australian patients with myocardial infarction (MI).

Objectives: This study: (1) describes prehospital delay time for patients with MI; (2) identifies variables and presenting symptoms which contribute to the delay.

Methods: This retrospective cohort study identified patients with an Emergency Department (ED) discharge diagnosis of MI, transported by ambulance to one of the seven Perth metropolitan EDs, between January 2008 and October 2009.

Characteristics and Outcomes of MI Patients with and without Chest Pain: A Cohort Study.

Introduction: There are conflicting data on patient characteristics and outcomes of myocardial infarction (MI) patients presenting with and without the symptom of chest pain.

Objectives: Compare the characteristics and survival of patients stratified by the symptom chest pain.

Methods: This retrospective cohort study identified patients with an emergency department discharge diagnosis of MI, who arrived by ambulance at a teaching hospital in Perth, Western Australia, between January 2008 to October 2009.

Paramedic Differentiation of Asthma and COPD in the Prehospital Setting Is Difficult.

Introduction: Separate clinical practice guidelines (CPG) for asthma and chronic obstructive pulmonary disease (COPD) often guide prehospital care. However, having distinct CPGs implies that paramedics can accurately differentiate these conditions. We compared the accuracy of paramedic identification of these two conditions against the emergency department (ED) discharge diagnosis.

Symptoms of myocardial infarction: concordance between paramedic and hospital records.

Introduction: To further reduce time to definitive therapy for acute myocardial infarction (MI) patients, the focus of research needs to be on better understanding prehospital delay in recognition and response to symptoms. Paramedic clinical records can serve as a convenient source of data for such studies, but their accuracy needs to be established.

Objectives: This study aimed to determine the concordance of the symptoms and symptom-onset time recorded in the paramedic patient care record (PCR) with those recorded in the hospital medical record for MI patients.