title: Heartstart Scotland: the use of paramedic skills in out of hospital resuscitation.
abstract: OBJECTIVE
  To assess the frequency with which paramedic skills were used in out of hospital cardiac arrest and the effect of tracheal intubation on outcome.
  
  
  METHODS
  Retrospective analysis of ambulance service reports and hospital records.
  
  
  METHODS
  Scottish Ambulance Service and hospitals admitting acute patients throughout Scotland.
  
  
  RESULTS
  A total of 8651 out of hospital resuscitation attempts were recorded and tracheal intubation was attempted in 3427 (39.6%) arrests. One hundred and thirty six patients (3.7%) were intubated and 476 (9.1%) of the patients who were not intubated survived to hospital discharge (p < 0.001). Among the patients who were defibrillated the proportion intubated was highest in the patients who received the greatest number of shocks (p < 0.01). Among subjects receiving similar numbers of shocks survival rates were lower for intubated patients (p < 0.01). Patients with unwitnessed arrests were most frequently intubated and survival rates were lowest in this group.
  
  
  CONCLUSIONS
  Patients who are intubated seem to have lower survival rates. This may however reflect the difficulty of the resuscitation attempt rather than the effects of intubation. The use of basic life support skills rapidly after cardiac arrest is associated with the best survival rates.
authors.affiliation: Department of Medical Cardiology, Royal Infirmary, Glasgow, UK.
authors.forename: J N
authors.initials: JN
authors.lastname: Adams
authors.forename: J
authors.initials: J
authors.lastname: Sirel
authors.forename: K
authors.initials: K
authors.lastname: Marsden
authors.forename: S M
authors.initials: SM
authors.lastname: Cobbe
mesh_terms: D016009:Chi-Square Distribution; D004554:Electric Countershock; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012606:Scotland; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome