title: Prehospital critical care for out-of-hospital cardiac arrest: An observational study examining survival and a stakeholder-focused cost analysis.
abstract: Survival rates from out-of-hospital cardiac arrest (OHCA) remain low, despite remarkable efforts to improve care. A number of ambulance services in the United Kingdom (UK) have developed prehospital critical care teams (CCTs) which attend critically ill patients, including OHCA. However, current scientific evidence describing CCTs attending OHCA is sparse and research to date has not demonstrated clear benefits from this model of care.
  
  
  
  This prospective, observational study will describe the effect of CCTs on survival from OHCA, when compared to advanced-life-support (ALS), the current standard of prehospital care in the UK. In addition, we will describe the association between individual critical care interventions and survival, and also the costs of CCTs for OHCA. To examine the effect of CCTs on survival from OHCA, we will use routine Utstein variables data already collected in a number of UK ambulance trusts. We will use propensity score matching to adjust for imbalances between the CCT and ALS groups. The primary outcome will be survival to hospital discharge, with the secondary outcome of survival to hospital admission. We will record the critical care interventions delivered during CCT attendance at OHCA. We will describe frequencies and aim to use multiple logistic regression to examine possible associations with survival. Finally, we will undertake a stakeholder-focused cost analysis of CCTs for OHCA. This will utilise a previously published Emergency Medical Services (EMS) cost analysis toolkit and will take into account the costs incurred from use of a helicopter and the proportion of these costs currently covered by charities in the UK.
  
  
  
  Prehospital critical care for OHCA is not universally available in many EMS. In the UK, it is variable and largely funded through public donations to charities. If this study demonstrates benefit from CCTs at an acceptable cost to the public or EMS commissioners, it will provide a rationale to increase funding and service provision. If no clinical benefit is found, the public and charities providing these services can consider concentrating their efforts on other areas of prehospital care.
  
  
  
  ISRCTN registry ID ISRCTN18375201 .
authors.affiliation: Faculty of Health and Life Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK. johannes.vopelius@gmail.com.|Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, Bristol, BS2 8HW, UK. johannes.vopelius@gmail.com.
authors.forename: Johannes
authors.identifier: 0000-0002-6389-289X
authors.initials: J
authors.lastname: von Vopelius-Feldt
authors.affiliation: Faculty of Health and Life Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Powell
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Morris
authors.affiliation: Faculty of Health and Life Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK.|Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Way, Bristol, BS2 8HW, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benger
mesh_terms: D000552:Ambulances / Q000458:organization & administration*; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D003365:Costs and Cost Analysis; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies; D012107:Research Design; D015996:Survival Rate; D006113:United Kingdom
keywords: Critical care; Emergency Medical Services; Heart Arrest