Overview Summary of Project
Each year in Northern Ireland, there are approximately 1,400 out-of-hospital cardiac arrests (OHCA). With an increasing incidence of up to one third of OHCA, pulseless electrical activity (PEA) continues to present a challenge for paramedics, due to inadequate diagnostic capabilities, coupled with a lack of clinical guidelines to inform decision-making. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) provide the only nationally accepted guideline for decision-making in PEA, which acknowledges the lack of supporting literature regarding termination of resuscitation for PEA in OHCA. Rapid transport to hospital and contacting senior clinical advice are key factors in JRCALC’s guidance, which is adopted by Northern Ireland Ambulance Service (NIAS) due to lack of a locally agreed decision tool. Subsequently, issues arise from failure to consider circumstances in which there is a lack of senior support, and transport is infeasible, which mirrors challenges faced by paramedics in Northern Ireland (NI). There is conflicting literature on the relationship between intra-arrest transport and survival rates, with one study concluding statistically significant higher survival rates with rapid intra-arrest transport, whilst another reports opposing statistically significant results of continued on scene resuscitation. Protracted transport times in NI, due to geographical and logistical constraints, in conjunction with the conflicting literature and absence of local PEA guidance, reinforces the difficultly faced by paramedics in deciding to terminate resuscitation. In NIAS, access to critical care clinical support is only available during the hours of 7am – 12am, depending on the availability of critical care paramedics, therefore, paramedics must rely on clinical judgement and shared decision-making to inform their rationale for termination of resuscitation of PEA. Despite the notable complexity of decision making in PEA, only one study exists exploring senior paramedic decision making when terminating PEA in OHCA in the United Kingdom. To date, no literature exists in relation to paramedic decision-making for PEA in NI, indicating the need for a study to understand how paramedics decide to terminate resuscitation in these circumstances. The proposed research question intends to develop evidence in this area for paramedics in NI.
Paramedics working for the Northern Ireland Ambulance Service will be contacted to voluntarily complete a survey consisting of quantitative and qualitative questions relating to decision-making for termination of resuscitation of pulseless electrical activity in adult out-of-hospital cardiac arrest. Quantitative data will be analysed using descriptive statistics to provide a summary of the participants, without making statistical inferences. Qualitative data will be analysed using reflexive thematic analysis and displayed in themes. The study will be written up and submitted to the University of Hertfordshire as part of a Master's degree in Advanced Paramedic Practice.
Questions
How do paramedics in Northern Ireland decide to terminate resuscitation in pulseless electrical activity (PEA) for adult 18 years and older out-of-hospital cardiac arrest, in the absence of a local decision tool?
