Scope Paramedic Practice Related To Cardiac

Scope Paramedic Practice Related To Cardiac

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Scope Paramedic Practice Related To Cardiac

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Scope Paramedic Practice Related To Cardiac

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Discuss About The Scope Paramedic Practice Related To Cardiac.


Paramedics refer to healthcare professionals, predominantly found to work in pre-hospital and out-of-hospital settings, who form an integral part of certain emergency medical services (EMS). The scope of paramedic practice often varies between different countries. However, it generally includes the process of autonomous decision making that is related to emergency care of patients (1). One such emergency situation frequently encountered by the paramedic professionals includes cardiac arrest. This condition refers to the sudden loss of blood flow that results in failure of the heart to pump blood in an efficient manner. This condition most often leads to loss of consciousness, and absence of breathing (2). Thus, a paramedic professionals bas the responsibility of playing an essential role in initial assessment of such patients, while providing necessary emergency care services. This literature review will discuss the scope of practice of all paramedics in relation to cardiac arrest.
An effective PICO question was initially formulated that was relevant to the main problem statement (3). Owing to the fact that the literature review was focused on cardiac arrest emergency paramedic procedures, the question formulated is given below:
Does paramedic practice among cardiac arrest patients improve survival?
The PICO elements are given below:



P (Problem)

Cardiac arrest

I (Intervention)

Paramedic services

C (Comparison)

*there was no comparison for this literature review*

O (Outcome)

Improved survival

Appropriate search terms were identified such as, “paramedic”, “paramedical”, “cardiac”, “heart”, “arrest”, “failure”, “attack”, “complications”, “cardiovascular”,  and “emergency”. The search terms were combined with the use of boolean operators such as, AND, OR and NOT (4). Three electronic databases were searched with these specific terms namely, PubMed, MEDLINE and CINAHL.
Use of these terms in combination with certain filters such as, full text, English articles that were published on or after 2013, helped in retrieving 35 articles that were relevant to the research question. Unpublished articles, manuscripts and articles published in foreign languages were also removed from the retrieved hits. However, after removing duplicate articles, and those which did not address all elements of the PICO question, 5 articles were selected for the review. The 5 full-text articles were assessed for their eligibility and relevance to the scope of paramedic practice in case of cardiac arrest. Each of these 5 articles focused on the different kinds of emergency care services that are provided by paramedics such as, understanding emergency pharmacology, restoring body temperature. The literature also included information on creating an open pathway in the lungs and implementing therapeutic hypothermia to reduce cardiovascular instability, and to protect the brain from ischemia.
The authors of one particular nation-wide population based study investigated the hypothesis that pre-hospital advanced airway management results in better outcomes among all patients having suffered a cardiac arrest. The study included 649,654 adult patients who were subjected to organized health care arrangement, after suffering from a cardiac arrest. The researchers primarily focused on evaluating the effects of bag-valve mask ventilation and advanced airway management as a part of the emergency services that are provided to all patients. The study results indicated that advanced airway management showed improved patient condition that eventually lead to favorable neurological outcomes of a score 0.38 (95% CI, 0.37-0.40) after the patients were adjusted for their sex, age, and etiology of cardiac arrest (5). Further reports from the study also indicated that administration of CPR with advanced airway management acted as a significant predictor of poor neurological outcomes among cardiac arrest patients, in comparison to the conventional bag-valve mask ventilation emergency services.
The effects of mechanical chest compression on the overall health outcome of cardiac arrest patients were investigated by another randomized controlled trial that compared manual CPR with mechanical CPR. The study was focused on out-of-hospital patients, having suffered from cardiac arrest, who were randomized to receive either of the two types of emergency CPR service. Results from the study suggested that no major differences were observed in the 4-hour survival rates of all patients, having received either of the two emergency services, thereby indicating that both types of cardiopulmonary resuscitation are effective for patients to immediately restore their heart rate and breathing, in paramedic care (6).
The effects of paramedic arrival on the survival of cardiac arrest patients were demonstrated by another study that was conducted on adults having received OHCA. Significant improvements and higher survival rates, followed by favorable neurological outcomes were reported among patients, following arrival or paramedic professionals, in comparison to presence of witnesses or bystanders (7).
Effects of therapeutic hypothermia, implemented upon children by paramedics, following an out-of-hospital cardiac arrest was investigated by another trial. The trial involved two different temperature interventions at children hospitals, where the children were randomly assigned to the two group within 6 hours of returning to circulation. No significant difference was observed in the survival rates of cardiac arrest patients, who were exposed to therapeutic hypothermia and nonhypothermia. The results showed differences with other trials and guidelines that had established therapeutic hypothermia as a major intervention to improve neurologic outcomes in cardiac arrest patients (8).
Similar investigations were conducted by another study that determined the effects of pre-hospital cooling as an emergency paramedic procedure on improved outcomes, following resuscitation in cardiac arrest patients. The RCT assigned the patients to standard care groups that were with or without pre-hospital cooling, in addition to normal saline infusion, following return of circulation. The results signified that pre-hospital cooling was found to reduce the core temperature by hospital arrival and also reduced the time needed to reach the optimum temperature of 34°C. However, no significant effects of this emergency paramedic procedure on neurological outcome or survival rates of the patient were observed (9).
Thus it can be concluded that the role of a paramedic professional is closely related to that of other healthcare positions, such as the emergency medical technician. The paramedics are offered higher responsibility and autonomy, while providing emergency care assistance to all patients. Thus, the paramedics play an important role in restoring the circulation and breathing of the cardiac arrest patients by CPR, resuscitation, and hypothermia.
McCann L, Granter E, Hassard J, Hyde P. Where next for the paramedic profession? An ethnography of work culture and occupational identity. Emerg Med J. 2015 May 1;32(5):e6-7.
Girotra S, Spertus JA, Li Y, Berg RA, Nadkarni VM, Chan PS, American Heart Association Get With the Guidelines–Resuscitation Investigators. Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get with the Guidelines–Resuscitation. Circulation: Cardiovascular Quality and Outcomes. 2013 Jan 1;6(1):42-9.
Hastings C, Fisher CA. Searching for proof: Creating and using an actionable PICO question. Nursing management. 2014 Aug 1;45(8):9-12.
McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. Journal of clinical epidemiology. 2016 Jul 1;75:40-6.
Hasegawa K, Hiraide A, Chang Y, Brown DF. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. Jama. 2013 Jan 16;309(3):257-66.
Rubertsson S, Lindgren E, Smekal D, Östlund O, Silfverstolpe J, Lichtveld RA, Boomars R, Ahlstedt B, Skoog G, Kastberg R, Halliwell D. Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: the LINC randomized trial. Jama. 2014 Jan 1;311(1):53-61.
Nehme Z, Andrew E, Bernard S, Smith K. Comparison of out-of-hospital cardiac arrest occurring before and after paramedic arrival: epidemiology, survival to hospital discharge and 12-month functional recovery. Resuscitation. 2015 Apr 1;89:50-7.
Moler FW, Silverstein FS, Holubkov R, Slomine BS, Christensen JR, Nadkarni VM, Meert KL, Clark AE, Browning B, Pemberton VL, Page K. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. New England Journal of Medicine. 2015 May 14;372(20):1898-908.
Kim F, Nichol G, Maynard C, Hallstrom A, Kudenchuk PJ, Rea T, Copass MK, Carlbom D, Deem S, Longstreth WT, Olsufka M. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. Jama. 2014 Jan 1;311(1):45-52.

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