Impact of Introducing an Advanced Care Paramedic Program on Clinical Outcomes for Out-of-Hospital Cardiac Arrest Patients Transported to Hospital

Abstract Introduction: Out-of-hospital cardiac arrest is a leading cause of mortality. Timely advanced life support, including the administration of epinephrine, improves clinical outcomes. This study evaluated the impact of introducing an advanced care paramedic program on key clinical outcomes, including return of spontaneous circulation, survival to hospital admission, and survival to hospital discharge. Methods: A retrospective health records review was conducted on patients with out-of-hospital cardiac arrest transported to a tertiary Canadian hospital. Patients were included if they were transported by emergency medical services to the emergency department between January 2010 and March 2019. Exclusion criteria included age under 18 years, arrest in the emergency department, trauma, or overdose-related arrests. Data were analyzed using chi-square tests, with a p-value <0.05 considered statistically significant. Results: Of the 390 patients identified, 228 (58.5%) from the pre-advanced care paramedic cohort and 162 (41.5%) from the post-advanced care paramedic cohort were included. Following the introduction of the advanced care paramedic program, return of spontaneous circulation was achieved by 67 out of 162 patients (41.3%) in the post-implementation group compared to 72 out of 228 patients (31.6%) in the pre-implementation group (OR 1.5, 95% CI 1.0-2.3, p=0.05). Survival to hospital admission increased from 34 out of 228 patients (14.9%) to 40 out of 162 patients (24.7%) (OR 2.0, 95% CI 1.2-3.3, p=0.015). Survival to hospital discharge increased from 7 out of 228 patients (3.1%) to 18 out of 162 patients (11.1%) (OR 4.8, 95% CI 2.0-11.5, p<0.001). Conclusion: The introduction of a regional advanced care paramedic program significantly improved clinical outcomes for patients experiencing out-of-hospital cardiac arrest. These findings support the integration of advanced care paramedics into prehospital care protocols.