JC: What is the impact of EMS practitioner experience on OHCA patient outcomes?

Study: Bray J, Nehme Z, Nguyen A, Lockey A, Finn J; Education, Implementation, Teams Task Force of the International Liaison Committee on Resuscitation. A systematic review of the impact of emergency medical service practitioner experience and exposure to out of hospital cardiac arrest on patient outcomes [published online ahead of print, 2020 Aug 5]. Resuscitation. 2020;S0300-9572(20)30302-6. doi:10.1016/j.resuscitation.2020.07.025

What they found?

  • no evidence to suggest practitioners with longer careers have improved patient outcomes (very low certainty of evidence)
  • suggests that EMS with greater recent exposure have improved patient outcomes (very low certainty of evidence)

Impact of year of career experience on OHCA outcomes

  • No studies examined survival with favourable neurologic outcome at discharge/30 days, event survival or ROSC
  • No association with survival to hospital discharge: median ≤5 career years reference group, 5-8 years adjusted odds ratio (AOR)=1.17 (95% CI: 0.99-1.39), 8-11 years AOR=1.11 (95% CI: 0.93-1.34), and >11 years AOR=10.09 (95% CI: 0.91-1.29).

Exposure to attempted resuscitation

  • Annual exposure for individual EMS personal vary: one study
    reported 11% of EMS personnel had no exposure to an attempted resuscitation over the 7 years (!)
  • Higher team exposure in the preceding 3 years was associated with increased survival to hospital discharge: compared to a median of ≤6 exposures, >6-11 exposures=AOR 1.26 (95% CI: 1.04–1.54), 11 to 17 exposures =AOR 1.29 (95% CI: 1.04–1.59), >17 exposures =AOR 1.50 (95% CI: 1.22–1.86).
  • Lower survival to discharge in patients treated by teams with no exposures in the preceding 6-months (AOR 0.70, 95% CI: 0.54–0.91) compared to those with recent exposure (<1 month)
  • Higher exposure of the treating paramedic was associated with
    increased ROSC
    • When compared to the <15 exposure reference group, those with ≥15 exposures had an AOR of 1.22 (95% CI 1.11–1.36)
    • association between ≥10 exposures for the lead paramedic over a one-year period and achievement of ROSC (OR 1.30, 95% CI 1.01–1.69)

In the future…

  • need for EMS to monitor OHCA exposure
  • need for further research exploring the relationship between EMS exposure and patient outcomes