Perspectives on cardiopulmonary resuscitation in the frail population: a scoping review.

Frail and elderly persons approaching end of life who suffer cardiac arrest are often subject to rigorous, undignified, and inappropriate resuscitation attempts despite poor outcomes. This scoping review aims to investigate how people feel about the appropriateness of CPR in this population. This review was guided by the PRISMA-ScR methodological framework.

Out-of-hospital cardiac arrests in Victoria, 2003-2022: retrospective analysis of Victorian Ambulance Cardiac Arrest Registry data.

Objectives: To examine changes in out-of-hospital cardiac arrest (OHCA) characteristics and outcomes during 2003-2022, and 12-month outcomes for people who experienced OHCA during 1 January 2010 - 30 June 2022.

Study Design: Retrospective observational study; analysis of Victorian Ambulance Cardiac Arrest Registry (VACAR) data.

Setting, Participants: OHCA events in Victoria not witnessed by emergency medical services personnel, 1 January 2003 - 31 December 2022.

Changes in out-of-hospital cardiac arrest resuscitation quality during and after the COVID-19 pandemic.

Aim: The impact of personal protective equipment (PPE) on resuscitation quality is largely unknown. We sought to examine the effect of PPE requirements on CPR quality and resuscitation interventions during the COVID-19 pandemic in Victoria, Australia.

Methods: We performed a retrospective cohort study of adult OHCA patients of medical aetiology who received attempted resuscitation.

Differences in ambulance attendances between children with and without an identified history of out-of-home-care.

Background: Children in out-of-home-care (OOHC) are a vulnerable population, typically with complex needs, however there is minimal research examining the behavioural presentations that lead to the increased use of acute emergency care by OOHC children.

Objective: This study aimed to describe differences in lifetime complexity factors identified during ambulance attendances between children with and without an identified history of OOHC. Further, this study aimed to describe whether having an identified history of being in OOHC was associated with increased utilisation of emergency care resources and increased likelihood of multiple ambulance attendances.

Prehospital use of spinal precautions by emergency medical services in children and adolescents.

Objectives: Limited evidence exists to guide the management of children with possible spinal injuries in the prehospital setting. As a first step to address this, we set out to describe the epidemiology and management of children <18 years presenting with possible cervical spinal injuries to EMS in Victoria, Australia.

Methods: Retrospective case record review of all children with concerns of head or neck trauma and/or documented cervical spine collar use presenting to the statewide Ambulance Victoria (AV) EMS service, Victoria, Australia, between 1 July 2019 and 30 June 2020.

Prehospital factors predicting mortality in patients with shock: state-wide linkage study.

Background: Patients with shock treated by emergency medical services (EMS) have high morbidity and mortality. Knowledge of prehospital factors predicting outcomes in patients with shock remains limited. We aimed to describe the prehospital predictors of mortality in patients with non-traumatic shock transported to hospital by EMS.

A Call to Action to Improve Cardiac Arrest Outcomes: A Report From the National Summit for Cardiac Arrest.

Sudden cardiac arrest (SCA) represents a major cause of premature mortality globally, with enormous impact and financial cost to victims, families, and communities. SCA prevention should be considered a health priority in Australia. National Cardiac Arrest Summits were held in June 2022 and March 2023, with inclusion from multi-faceted endeavours related to SCA prevention.

Paramedic perceptions of conveying patients to an emergency department who were suitable for primary care: a cross-sectional survey.

Background Ambulance callouts and conveyances continue to increase disproportionately to population growth. This is largely driven by low- and medium-acuity patients who do not require ambulance management. We aimed to estimate the proportion of patients paramedics have conveyed to an emergency department (ED) via ambulance whom they considered suitable for primary care, and understand the barriers that contributed to these decisions.

Real-time feedback for CPR quality - A scoping review.

Background: Previous systematic reviews have failed to find an association between the use of real-time feedback during cardiopulmonary resuscitation (CPR) and patient outcomes. However, these reviews excluded studies examining feedback with other system changes. As part of the International Liaison Committee on Resuscitation (ILCOR) continuous evidence evaluation process, we conducted a scoping review to examine the current state of this literature and the use of real-time feedback in this form.

Long-term effects of a coalmine fire on hospital and ambulance use: An interrupted time series study.

Background: In 2014, the Hazelwood coalmine fire in regional Victoria, Australia shrouded nearby communities in smoke for six weeks. Prior investigations identified substantial adverse effects, including increases in the use of health services. In this study, we examined the effects on hospital and ambulance use in the eight years following the fire.

Prevalence and Predictors of Emergency Medical Service Use in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction.

Aim: We aim to describe prevalence of Emergency Medical Service (EMS) use, investigate factors predictive of EMS use, and determine if EMS use predicts treatment delay and mortality in our ST-elevation myocardial infarction (STEMI) cohort.

Method: We prospectively collected data on 5,602 patients presenting with STEMI for primary percutaneous coronary intervention (PCI) transported to PCI-capable hospitals in Victoria, Australia, from 2013-2018 who were entered into the Victorian Cardiac Outcomes Registry (VCOR). We linked this dataset to the Ambulance Victoria and National Death Index (NDI) datasets.

Temporal trends in the incidence and outcomes of shock-refractory ventricular fibrillation out-of-hospital cardiac arrest.

Aim: We aimed to describe trends in the incidence and outcomes of refractory ventricular fibrillation (RVF) compared to non-refractory ventricular fibrillation (non-RVF) in out-of-hospital cardiac arrest (OHCA).

Methods: Between 2010 and 2019, we included all OHCA cases involving adults ≥ 16 years old with an initial shockable rhythm and who received an attempted resuscitation by Emergency Medical Services (EMS) or a bystander shock prior to EMS arrival in Victoria, Australia. Trends in incidence and survival outcomes over the study period were examined.

Characteristics and Outcomes of Patients Referred to a General Practitioner by Victorian Paramedics.

Objective: Many patients who are attended by paramedics do not require conveyance to an emergency department (ED). Our study focuses on comparing the characteristics and outcomes of patients who were advised to follow up with a general practitioner (GP) by an attending paramedic with those of patients who were discharged at scene or transported to hospital.

Methods: This was a retrospective data linkage cohort study of ambulance, ED, hospital admission, and death records for all adults attended by paramedics in Victoria, Australia between the 1 of January 2015 and 30 of June 2019.

Using ambulance surveillance data to characterise blood-borne viral infection histories among patients presenting with acute alcohol and other drug-related harms.

Objective: Preventable transmission of blood-borne viruses (BBV), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV), continue in at-risk populations, including people who use alcohol and drugs (AODs). To our knowledge, no studies have explored the use of ambulance data for surveillance of AOD harms in patients with BBV infections.

Methods: We used electronic patient care records from the National Ambulance Surveillance System for people who were attended by an ambulance in Victoria, Australia between July 2015 and July 2016 for AOD-related harms, and with identified history of a BBV infection.

Outcomes of patients with refractory out-of-hospital cardiac arrest transported to an ECMO centre compared with transport to non-ECMO centres.

To compare the outcomes of patients with refractory out-of-hospital cardiac arrest (OHCA) transported to a hospital that provides extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) with patients transported to hospitals without ECPR capability. Retrospective review of patient care records in a pre-hospital and hospital setting. Adult patients with OHCA who left the scene and arrived with cardiopulmonary resuscitation in progress at 16 hospitals in Melbourne, Australia, between January 2016 and December 2019.

The impact of ventricular fibrillation amplitude on successful cardioversion, resuscitation duration, and survival after out-of-hospital cardiac arrest.

We sought to examine the incidence of low amplitude ventricular fibrillation and its impact on successful cardioversion, duration of resuscitation, and survival to hospital discharge in patients with out-of-hospital cardiac arrest (OHCA). Retrospective analysis from a statewide registry. Victoria, Australia.

The impact of COVID-19 pandemic on out-of-hospital cardiac arrest: An individual patient data meta-analysis.

Aim: Prior studies have reported increased out-of-hospital cardiac arrests (OHCA) incidence and lower survival during the COVID-19 pandemic. We evaluated how the COVID-19 pandemic affected OHCA incidence, bystander CPR rate and patients' outcomes, accounting for regional COVID-19 incidence and OHCA characteristics.

Methods: Individual patient data meta-analysis of studies which provided a comparison of OHCA incidence during the first pandemic wave (COVID-period) with a reference period of the previous year(s) (pre-COVID period).

Modelled economic evaluation of a virtual emergency department in Victoria.

Objective: Virtual ED (VED) can potentially alleviate ED overcrowding which has been a public health challenge. The aim of the present study was to conduct a return-on-investment analysis of a VED programme developed in response to changing healthcare needs in Australia.

Methods: An economic model was developed based on initial patient outcome data to assess the healthcare costs, potential costs saved and return on investment (ROI) from the VED.

A study protocol for a cluster-randomised controlled trial of smartphone-activated first responders with ultraportable defibrillators in out-of-hospital cardiac arrest: The First Responder Shock Trial (FIRST).

Objective: To describe the First Responder Shock Trial (FIRST), which aims to determine whether equipping frequently responding, smartphone-activated (GoodSAM) first responders with an ultraportable AED can increase 30-day survival rates in OHCA.

Methods: The FIRST trial is an investigator-initiated, bi-national (Victoria, Australia and New Zealand), registry-nested cluster-randomised controlled trial where the unit of randomisation is the smartphone-activated (GoodSAM) first responder. High-frequency GoodSAM responders are randomised 1:1 to receive an ultraportable, single-use AED or standard alert procedures using the GoodSAM app.

A two-point strategy to clarify prognosis in >80 year olds experiencing out of hospital cardiac arrest.

Background: The global population is aging, with the number of ≥80-year-olds projected to triple over the next 30 years. Rates of out-of-hospital cardiac arrest (OHCA) are also increasing within this age group.

Methods: The Victorian Ambulance Cardiac Arrest Registry was utilised to identify OHCAs in patients aged ≥80 years between 2002-2021.