Does critical care paramedic deployment improve delivery of post-resuscitation care following out-of-hospital cardiac arrest? A retrospective cohort study.

Introduction: The return of spontaneous circulation (ROSC) care bundle is a set of interventions designed by NHS England for use in the post-resuscitation care of patients following out-of-hospital cardiac arrest (OHCA). Compliance with these standards is critical in providing optimal, standardised care and in improving outcomes. This study aimed to investigate the impact of critical care paramedics (CCPs) on delivery of post-ROSC care. Methods: A retrospective observational study was conducted across a large UK ambulance service. All patients with sustained ROSC following resuscitation for OHCA over a one-year period were included. The post-ROSC care delivered to two groups was compared - a standard care group, and a group where a CCP was present. Results: The study included 997 incidents: 106 incidents in the non-CCP group and 891 incidents in the CCP group. The presence of a CCP was associated with a statistically significant increase in compliance with the ROSC bundle. Of incidents with a CCP present, 75% were fully compliant, compared with 64% of incidents without a CCP. The mean percentage compliance across the standards was significantly higher in the CCP group. Secondary outcome analysis showed statistically significant benefits in compliance for several care parameters when a CCP was present. Conclusion: This retrospective study confirms that the presence of a CCP improves delivery of post-ROSC care. This highlights the potential benefits of having CCPs as part of the standard pre-hospital care resuscitation team. Further research is needed to confirm these findings and to examine the relationship between the ROSC bundle and patient outcomes.