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 “Cardiac arrest is a leading cause of death worldwide,” said lead
author Kylie Dyson of the school of public health and preventive
medicine at Monash University in Melbourne.
“Ambulance Victoria attend approximately 5,000 cardiac arrests a
year,” Dyson said. “Due to the large service area and workforce,
individual paramedics only treat around two cardiac arrests a year.”
The researchers matched data from a cardiac arrest registry to an
ambulance employment database for the years 2003 to 2012 in
Victoria, Australia. They tallied each time a paramedic responding
to a cardiac arrest had responded in the previous three years to one
where resuscitation was attempted.
During the study period, more than 4,000 paramedics worked in the
area and there were more than 48,000 out of hospital cardiac
arrests, with resuscitation attempts in 44% of cases.
Half of the paramedics had been exposed to at least two cardiac
arrests per year, while half had less experience; 11% of the
paramedics had not been exposed to any cardiac arrest cases.
Half of treating paramedics who attempted to resuscitate an out of
hospital cardiac arrest victim had responded to at least 11 cardiac
arrests outside hospitals over the preceding three years.
About 7% of patients treated by paramedics who had experienced six
or fewer cardiac arrests over the previous three years survived.
That compared to 12% of those treated by paramedics who had
responded to between seven and 11 cardiac arrests.
When treated by paramedics who had responded to up to 17 previous
cardiac arrests or more, 14% to 17% of patients survived, according
to the results published January 26 in Circulation: Cardiovascular
Quality and Outcomes.
“Paramedics attend about 5,000 cardiac arrests every year across the
state,” said Anthony Carlyon, acting general manager for emergency
operations for Ambulance Victoria, who was not part of the new
study.
“Our cardiac arrest results are very impressive, with our survival
rates among the world’s best,” Carlyon told Reuters Health in a
statement. “About 30% of people whose heart is in a shockable rhythm
survive, which is a 10-fold increase compared to survival rates in
1995.”
Following a review, Ambulance Victoria is significantly increasing
the number of hours dedicated to training for all paramedics
annually, Carlyon added.
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Resuscitation skills are complex and difficult to perform, and
deteriorate rapidly over time for all professions, including
doctors, nurses and paramedics, Dyson said.
“Our study indicates that paramedics may need six-monthly exposure
or training to prevent skill decay and improve survival,” Dyson told
Reuters Health by email. “The results of our study are likely to
have implications for other settings and other healthcare
professionals as well.”
In the Netherlands, paramedics are retrained in cardiac arrest every
five years, said Dr. Jocelyn Berdowski of the Academic Medical
Center University of Amsterdam.
“Preparing a resuscitation attempt on a real person is very
different than practicing on a mannequin,” Berdowski, who was not
part of the new study, told Reuters Health by email. “My advice
would be to take a refresher course (at least) once a year, and
train realistic scenarios.”
There’s no way to increase actual paramedic exposure to cardiac
arrest, but organizations could try formal debriefing after every
cardiac arrest to ensure that paramedics learn from every case they
treat, Dyson said.
“In addition to actual exposure, we could simulate cardiac arrest to
give paramedics more opportunity to practice their skills,” Dyson
said.
SOURCE: http://bit.ly/1Sld9z9
Circ Cardiovas Qual Outcomes 2016.
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