• Paramedic initiated Lisinopril for acute stroke treatment (PIL-FAST): results from the pilot randomised controlled trial

      Shaw, Lisa; Price, Christopher; McLure, Sally; Howel, Denise; McColl, Elaine; Younger, Paul; Ford, Gary A. (2014-12)
      Background High blood pressure (BP) during acute stroke is associated with poorer stroke outcome. Trials of treatments to lower BP have not resulted in improved outcome, but this may be because treatment commenced too late. Emergency medical service staff (paramedics) are uniquely placed to administer early treatment; however, experience of prehospital randomised controlled trials (RCTs) is very limited. Methods We conducted a pilot RCT to determine the feasibility of a definitive prehospital BP-lowering RCT in acute stroke. Paramedics were trained to identify, consent and deliver a first dose of lisinopril or placebo to adults with suspected stroke and hypertension while responding to the emergency call. Further treatment continued in hospital. Study eligibility, recruitment rate, completeness of receipt of study medication and clinical data (eg, BP) were collected to inform the design of a definitive RCT. Results In 14 months, 14 participants (median age=73 years, median National Institute of Health Stroke Scale=4) were recruited and received the prehospital dose of medication. Median time from stroke onset (as assessed by paramedic) to treatment was 70 min. Four participants completed 7 days of study treatment. Of ambulance transported suspected stroke patients, 1% were both study eligible and attended by a PIL-FAST paramedic. Conclusions It is possible to conduct a paramedic initiated double-blind RCT of a treatment for acute stroke. However, to perform a definitive RCT in a reasonable timescale, a large number of trained paramedics across several ambulance services would be needed to recruit the number of patients likely to be required. https://emj.bmj.com/content/emermed/31/12/994.full.pdf This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/emermed-2013-202536
    • A randomized trial of epinephrine in out-of-hospital cardiac arrest

      Perkins, Gavin D.; Ji, Chen; Deakin, Charles D.; Quinn, Tom; Nolan, Jerry P.; Scomparin, Charlotte; Regan, Scott; Long, John; Slowther, Anne-Marie; Pocock, Helen; et al. (2018-08)
    • Regionalised cardiac arrest centres as a means to improve outcomes from out-of-hospital cardiac arrest in the UK: a literature review

      Miles, Steven (2016-12)
      Abstract published with permission. Introduction ‐ Sudden (out-of-hospital) cardiac arrest (OHCA) is recognised as a leading cause of death in the UK; however, survival rates remain significantly lower in the UK than in other developed countries such as Norway and Holland, which have specialised regional cardiac arrest systems and centres. Aims ‐ This review aims to look at the concept and potential benefits of specialised regional cardiac arrest centres, and to consider whether development of such centres, with bypass protocols to enable transportation of OHCA patients directly to these centres, could improve survival rates and patient outcomes in the UK. Methods ‐ Literature was identified through searching MEDLINE, ProQuest Central, CINAHL and PubMed Central databases, as well as relevant national websites, with the search terms ‘cardiac arrest’, ‘regionalised care’ and ‘out-of-hospital cardiac arrest’. Further screening used the inclusion criteria of publication within the previous 10 years (2006‐2016), English language and peer reviewed journals. Exclusion criteria included duplicated articles, articles with a primary focus on in-hospital arrests and focus on causes and prevention of cardiac arrest. Forty-three records resulted and their full texts were considered and reviewed individually to identify those supported by other sources and containing information to add to understanding of the topic Results ‐ A range of evidence is found to support the development of specialised regional cardiac arrest centres, with bypass protocols to enable ambulance staff to transport directly to these centres. Essential facilities for cardiac arrest centres are identified and potential barriers to development of these centres are discussed. Utilisation of paramedics with additional equipment and skills is considered to enable direct admissions to regional cardiac arrest centres to be effective. Conclusions ‐ Cardiac arrest centres, alongside bypass protocols to enable direct admission, could improve patient outcomes and survival rates for OHCA in the UK. For these measures to be effective some barriers to change need to be addressed and paramedics with additional skills and equipment used. Evidence from within the UK itself appears limited. Further research is needed within the UK, involving a multidisciplinary approach, with close working partnership between hospitals and the ambulance service in relation to development of regional cardiac arrest centres.