title: The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  To assess the impact of a pre-hospital critical care team (CCT) on survival from out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  We undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups. The primary outcome was survival to hospital discharge. All data were collected independently of the research.
  
  
  RESULTS
  1851 cases of OHCA were included in the analysis, of which 1686 received ALS paramedic treatment and 165 were attended by both ALS paramedics and a CCT. Unadjusted rates of survival to hospital discharge were significantly higher in the CCT group, compared to the ALS paramedic group (15.8% and 6.5%, respectively, p<0.001). After adjustment using multiple logistic regression, the effect of CCT treatment was no longer statistically significant (OR 1.54, 95% CI 0.89-2.67, p=0.13). Subgroup analysis of OHCA with first monitored rhythm of ventricular fibrillation or pulseless ventricular tachycardia showed similar results.
  
  
  CONCLUSIONS
  Pre-hospital critical care for OHCA was not associated with significantly improved rates of survival to hospital discharge. These results are in keeping with previously published studies. Further research with a larger sample size is required to determine whether CCTs can improve outcome in OHCA.
authors.affiliation: Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom. Electronic address: johannes.vopelius@gmail.com.
authors.forename: Johannes
authors.initials: J
authors.lastname: von Vopelius-Feldt
authors.affiliation: North Bristol NHS Trust, Southmead Road, BS10 5NB Bristol, United Kingdom.
authors.forename: Archibald
authors.initials: A
authors.lastname: Coulter
authors.affiliation: Academic Emergency Department, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, BS2 8HW Bristol, United Kingdom; University of the West of England, Bristol, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benger
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D004632:Emergency Medical Services; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D010348:Patient Care Team / Q000592:standards*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology; D000078329:Workforce
keywords: Advanced life support; Emergency medical systems; Out-of-hospital cardiac arrest; Pre-hospital critical care