Skip to main content
NCBI home page
Heart logoLink to Heart
. 1997 Oct;78(4):399–402. doi: 10.1136/hrt.78.4.399

Heartstart Scotland: the use of paramedic skills in out of hospital resuscitation

J Adams 1, J Sirel 1, K Marsden 1, S Cobbe 1
PMCID: PMC1892267  PMID: 9404259

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.
Design—Retrospective analysis of ambulance service reports and hospital records.
Setting—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.

 Keywords: paramedics;  resuscitation;  myocardial infarction;  tracheal intubation;  prehospital care

Full Text

The Full Text of this article is available as a PDF (94.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arntz H. R., Oeff M., Willich S. N., Storch W. H., Schröder R. Establishment and results of an EMT-D program in a two-tiered physician-escorted rescue system. The experience in Berlin, Germany. Resuscitation. 1993 Aug;26(1):39–46. doi: 10.1016/0300-9572(93)90161-i. [DOI] [PubMed] [Google Scholar]
  2. Cobbe S. M., Redmond M. J., Watson J. M., Hollingworth J., Carrington D. J. "Heartstart Scotland"--initial experience of a national scheme for out of hospital defibrillation. BMJ. 1991 Jun 22;302(6791):1517–1520. doi: 10.1136/bmj.302.6791.1517. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cummins R. O., Chamberlain D. A., Abramson N. S., Allen M., Baskett P. J., Becker L., Bossaert L., Delooz H. H., Dick W. F., Eisenberg M. S. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation. 1991 Aug;84(2):960–975. doi: 10.1161/01.cir.84.2.960. [DOI] [PubMed] [Google Scholar]
  4. Eisenberg M. S., Copass M. K., Hallstrom A. P., Blake B., Bergner L., Short F. A., Cobb L. A. Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med. 1980 Jun 19;302(25):1379–1383. doi: 10.1056/NEJM198006193022502. [DOI] [PubMed] [Google Scholar]
  5. Enns J., Tweed W. A., Donen N. Prehospital cardiac rhythm deterioration in a system providing only basic life support. Ann Emerg Med. 1983 Aug;12(8):478–481. doi: 10.1016/s0196-0644(83)80641-6. [DOI] [PubMed] [Google Scholar]
  6. Guly U. M., Mitchell R. G., Cook R., Steedman D. J., Robertson C. E. Paramedics and technicians are equally successful at managing cardiac arrest outside hospital. BMJ. 1995 Apr 29;310(6987):1091–1094. doi: 10.1136/bmj.310.6987.1091. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Herlitz J., Ekström L., Wennerblom B., Axelsson A., Bång A., Holmberg S. Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside hospital. Br Heart J. 1994 Nov;72(5):408–412. doi: 10.1136/hrt.72.5.408. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Herlitz J., Ekström L., Wennerblom B., Axelsson A., Bång A., Holmberg S. Survival in patients found to have ventricular fibrillation after cardiac arrest witnessed outside hospital. Eur Heart J. 1994 Dec;15(12):1628–1633. doi: 10.1093/oxfordjournals.eurheartj.a060445. [DOI] [PubMed] [Google Scholar]
  9. Lombardi G., Gallagher J., Gennis P. Outcome of out-of-hospital cardiac arrest in New York City. The Pre-Hospital Arrest Survival Evaluation (PHASE) Study. JAMA. 1994 Mar 2;271(9):678–683. [PubMed] [Google Scholar]
  10. Sedgwick M. L., Dalziel K., Watson J., Carrington D. J., Cobbe S. M. Performance of an established system of first responder out-of-hospital defibrillation. The results of the second year of the Heartstart Scotland Project in the 'Utstein Style'. Resuscitation. 1993 Aug;26(1):75–88. doi: 10.1016/0300-9572(93)90166-n. [DOI] [PubMed] [Google Scholar]
  11. van der Hoeven J. G., Waanders H., Compier E. A., van der Weyden P. K., Meinders A. E. Evaluation of an emergency medical system. The prognosis in patients with an out-of-hospital cardiac arrest. Neth J Med. 1994 Jan;44(1):5–11. [PubMed] [Google Scholar]
  12. van der Hoeven J. G., de Koning J., van der Weyden P. K., Meinders A. E. Improved outcome for patients with a cardiac arrest by supervision of the emergency medical services system. Neth J Med. 1995 Mar;46(3):123–130. doi: 10.1016/0300-2977(94)00106-j. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES