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Main SE, Sidebottom DB, Deakin CD, Raitt J, Pocock H, Hannah J, Plumb JO. Effectiveness of combinations of active compression-decompression cardiopulmonary resuscitation, impedance threshold devices and head-up cardiopulmonary resuscitation in adult out-of-hospital cardiac arrest: A systematic review. Resusc Plus 2024; 20:100760. [PMID: 39309748 PMCID: PMC11413749 DOI: 10.1016/j.resplu.2024.100760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/18/2024] [Accepted: 08/21/2024] [Indexed: 09/25/2024] Open
Abstract
Objective This review summarises the current evidence base for combinations of neuroprotective CPR adjuncts (active compression-decompression chest compressions, impedance threshold devices, and head-up positioning) during out-of-hospital cardiac arrest. Methods A systematic search (PROSPERO registration CRD42023432302) was performed in English on MEDLINE, EMBASE, and the Cochrane Library in August 2023, and repeated in February 2024. All randomised and observational studies (not abstracts) reporting on any combination of the aforementioned CPR adjuncts were included. Papers were screened independently by two researchers, with a third reviewer acting as tiebreaker. Out-of-hospital, non-traumatic, cardiac arrests in patients >18 years were eligible for inclusion. Risk of bias was assessed using the Risk of Bias 2 tool and the Newcastle-Ottawa scale. Results Eight of 1172 unique articles identified in the initial searches were included, with five randomised controlled trials and three observational studies. No randomised trial investigated a bundle of all three interventions. All randomised controlled trials were at intermediate or high risk of bias. Neurologically favourable survival was greater in patients treated with an impedance threshold device and active compression-decompression CPR when compared to standard CPR (8.9% vs 5.8%, p = 0.019) in the largest existing randomised trial. Conflicting results were found in observational studies comparing the complete neuroprotective bundle to standard CPR. Conclusions This review was limited by small study numbers and overlapping samples, which precluded a meta-analysis. Limited data suggests that combinations of adjuncts to improve cerebral perfusion during CPR may improve survival with favourable neurological outcome. A randomised controlled trial is required to establish whether combining all three together results in improved outcomes.
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Affiliation(s)
| | - David B. Sidebottom
- University Hospital Southampton NHS Foundation Trust, United Kingdom
- Södertälje Sjukhus, Stockholm, Sweden
| | - Charles D. Deakin
- University Hospital Southampton NHS Foundation Trust, United Kingdom
- South Central Ambulance Service NHS Foundation Trust, United Kingdom
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, Southampton NHS Foundation Trust, United Kingdom
| | - James Raitt
- Thames Valley Air Ambulance, United Kingdom
- Frimley Park Hospital, United Kingdom
| | - Helen Pocock
- South Central Ambulance Service NHS Foundation Trust, United Kingdom
| | - Julian Hannah
- Hampshire and Isle of Wight Air Ambulance, United Kingdom
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, Southampton NHS Foundation Trust, United Kingdom
| | - James O.M. Plumb
- Hampshire and Isle of Wight Air Ambulance, United Kingdom
- University Hospital Southampton NHS Foundation Trust, United Kingdom
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, Southampton NHS Foundation Trust, United Kingdom
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Bowles KA, Batt AM, O'Toole M, Knox S, Hemingway L, Williams J, Williams B, Cummins NM. Identifying the essential elements to inform the development of a research agenda for Paramedicine in Ireland: a Delphi Study. Health Res Policy Syst 2024; 22:100. [PMID: 39123273 PMCID: PMC11313103 DOI: 10.1186/s12961-024-01188-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Paramedicine is a dynamic profession which has evolved from a "treat and transport" service into a complex network of health professionals working in a diverse range of clinical roles. Research is challenging in the paramedicine context, and internationally, research capacity and culture has developed slowly. International examples of research agendas and strategies in paramedicine exist, however, research priorities have not previously been identified in Ireland. METHODS This study was a three round electronic modified Delphi design which aimed to establish the key aspects of the research priorities via end-user consensus. Participants included interested stakeholders involved in prehospital care or research in Ireland. The first round questionnaire consisted of open-ended questions with results coded and developed into themes for the closed-ended questions used in the second and third round questionnaires. A consensus level of 70% was set a priori for second and third rounds. RESULTS Research Priorities that reached consensus included Staff Wellbeing, Education and Professionalism and Acute Medical Conditions. Respondents indicated that these three areas should be a priority in the next 2 years. Education, Staffing and Leadership were imperative Key Resources that required change. Education was a Key Processes change deemed imperative to allow the future research to occur. Outcomes that should be included in the future research strategy were Patient Outcomes, Practitioner Development, Practitioner Wellbeing, Alternate Pathways, Evidence-based Practice and Staff Satisfaction. CONCLUSION The results of this study are similar to previously published international studies, with some key differences. There was a greater emphasis on Education and Practitioner Wellbeing with the latter possibly attributed to the timing of the research in relation to the COVID-19 pandemic. The disseminated findings of this study should inform sustainable funding models to aid the development of paramedicine research in Ireland.
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Affiliation(s)
- Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Melbourne, Australia.
| | - Alan M Batt
- Department of Paramedicine, Monash University, Melbourne, Australia
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Michelle O'Toole
- Department of Paramedicine, Monash University, Melbourne, Australia
- RCSI SIM, Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Irish Paramedicine Education and Research Network (IPERN), Limerick, Ireland
| | - Shane Knox
- National Ambulance Service, Dublin, Ireland
- School of Medicine, University College Cork, Cork, Ireland
| | - Liam Hemingway
- Department of Paramedicine, Monash University, Melbourne, Australia
| | - Julia Williams
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Brett Williams
- Department of Paramedicine, Monash University, Melbourne, Australia
| | - Niamh M Cummins
- Department of Paramedicine, Monash University, Melbourne, Australia
- Irish Paramedicine Education and Research Network (IPERN), Limerick, Ireland
- School of Medicine, SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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McHenry RD, Smith CA. The association between geospatial and temporal factors and pre-hospital response to major trauma: a retrospective cohort study in the North of England. Scand J Trauma Resusc Emerg Med 2023; 31:103. [PMID: 38115110 PMCID: PMC10729533 DOI: 10.1186/s13049-023-01166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/08/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Major trauma is a leading cause of premature death and disability worldwide, and many healthcare systems seek to improve outcomes following severe injury with provision of pre-hospital critical care. Much research has focussed on the efficacy of pre-hospital critical care and advanced pre-hospital interventions, but less is known about how the structure of pre-hospital critical care services may influence response to major trauma. This study assessed the association between likelihood of pre-hospital critical care response in major trauma and factors important in the planning and development of those services: geographic isolation, time of day, and tasking mechanism. METHODS A local trauma registry, supported with data from the Trauma Audit and Research Network alongside additional information regarding pre-hospital management, identified patients sustaining major trauma admitted to Major Trauma Centres in the North of England. Data was extracted on location and time of incident, mechanism of injury, on-scene times, and presence or absence of pre-hospital critical care team. An isochrone map was constructed for 30-minute intervals to regional Major Trauma Centres, defining geographic isolation. Univariate logistic regression compared likelihood of pre-hospital critical care response to that of conventional ambulance response for varying degrees of geographic isolation, day or night period, and mechanism of injury, and multiple linear regression assessed the association between geographic isolation, service response and on-scene time. RESULTS 2619 incidents were included, with 23.3% attended by pre-hospital critical care teams. Compared to conventional ambulance services, pre-hospital critical care teams were more likely to respond major trauma in areas of greater geographic isolation (OR 1.42, 95% CI 1.30-1.55, p < 0.005). There were significant differences in the mechanism of injury attended and no significant difference in response by day or night period. Pre-hospital critical care team response and increasing geographic isolation was associated with longer on-scene times (p < 0.005). CONCLUSION Pre-hospital critical care teams are more likely to respond to major trauma in areas of greater geographic isolation. Enhanced pre-hospital care may mitigate geographic inequalities when providing advanced interventions and transport of severely injured patients. There may be an unmet need for pre-hospital critical care response in areas close to major hospitals.
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Affiliation(s)
- Ryan D McHenry
- ScotSTAR, Scottish Ambulance Service, Hangar B, 180 Abbotsinch Road, Paisley, PA3 2RY, UK.
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Cimino J, Braun C. Clinical Research in Prehospital Care: Current and Future Challenges. Clin Pract 2023; 13:1266-1285. [PMID: 37887090 PMCID: PMC10605888 DOI: 10.3390/clinpract13050114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/08/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Prehospital care plays a critical role in improving patient outcomes, particularly in cases of time-sensitive emergencies such as trauma, cardiac failure, stroke, bleeding, breathing difficulties, systemic infections, etc. In recent years, there has been a growing interest in clinical research in prehospital care, and several challenges and opportunities have emerged. There is an urgent need to adapt clinical research methodology to a context of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. Among these, this review allows the highlighting of limited resources and infrastructure, ethical and regulatory considerations, time constraints, privacy, safety concerns, data collection and analysis, selection of a homogeneous study group, etc. The analysis of the literature also highlights solutions such as strong collaboration between emergency medical services (EMS) and hospital care, use of (mobile) health technologies and artificial intelligence, use of standardized protocols and guidelines, etc. Overall, the purpose of this narrative review is to examine the current state of clinical research in prehospital care and identify gaps in knowledge, including the challenges and opportunities for future research.
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Affiliation(s)
- Jonathan Cimino
- Clinical Research Unit, Fondation Hôpitaux Robert Schuman, 44 Rue d’Anvers, 1130 Luxembourg, Luxembourg
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540 Luxembourg, Luxembourg
| | - Claude Braun
- Clinical Research Unit, Fondation Hôpitaux Robert Schuman, 44 Rue d’Anvers, 1130 Luxembourg, Luxembourg
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540 Luxembourg, Luxembourg
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Cottey L, Shanahan TAG, Gronlund T, Whiting C, Sokunbi M, Carley SD, Smith JE. Refreshing the emergency medicine research priorities. Emerg Med J 2023; 40:666-670. [PMID: 37491155 PMCID: PMC10447359 DOI: 10.1136/emermed-2022-213019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The priorities for UK emergency medicine research were defined in 2017 by a priority setting partnership coordinated by the Royal College of Emergency Medicine in collaboration with the James Lind Alliance (JLA). Much has changed in the last 5 years, not least a global infectious disease pandemic and a significant worsening of the crisis in the urgent and emergency care system. Our aim was to review and refresh the emergency medicine research priorities. METHODS A steering group including patients, carers and healthcare professionals was established to agree to the methodology of the refresh. An independent adviser from the JLA chaired the steering group. The scope was adult patients in the ED. New questions were invited via an open call using multiple communications methods ensuring that patients, carers and healthcare professionals had the opportunity to contribute. Questions underwent minisystematic (BestBETs) review to determine if the question had been answered, and the original 2017 priorities were reviewed. Any questions that remained unanswered were included in an interim prioritisation survey, which was distributed to patients, carers and healthcare professionals. Rankings from this survey were reviewed by the steering group and a shortlist of questions put forward to the final workshop, which was held to discuss and rank the research questions in order of priority. RESULTS 77 new questions were submitted, of which 58 underwent mini-systematic review. After this process, 49 questions (of which 32 were new, 11 were related to original priorities and 6 unanswered original priorities were carried forward) were reviewed by the steering group and included in an interim prioritisation survey. The interim prioritisation survey attracted 276 individual responses. 26 questions were shortlisted for discussion at the final prioritisation workshop, where the top 10 research priorities were agreed. CONCLUSION We have redefined the priorities for emergency medicine research in the UK using robust and established methodology, which will inform the agenda for the coming years.
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Affiliation(s)
- Laura Cottey
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | | | - Toto Gronlund
- James Lind Alliance, National Institute for Health and Care Research, School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
| | - Caroline Whiting
- James Lind Alliance, National Institute for Health and Care Research, School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
| | - Moses Sokunbi
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Simon David Carley
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
- Postgraduate Medicine, Manchester Metropolitan University, Manchester, UK
| | - Jason E Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Ramage L, McLachlan S. Top research priorities in prehospital critical care. Emerg Med J 2023; 40:536-537. [PMID: 36898825 DOI: 10.1136/emermed-2023-213120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Affiliation(s)
- Lisa Ramage
- Emergency Department, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
- MAGPAS Air Ambulance, Huntingdon, Cambridgeshire, UK
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, UK
| | - Sarah McLachlan
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, UK
- Anglia Ruskin University, Chelmsford, Essex, UK
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Hodkinson ME. Top research priorities in prehospital critical care. Emerg Med J 2023; 40:536. [PMID: 36898824 DOI: 10.1136/emermed-2023-213116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/12/2023]
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