Literature Review on the Scope of Paramedic Practice in Cardiac Arrest

This literature review examines the scope of paramedic practice in managing cardiac arrest, a critical emergency medical situation. It explores various interventions and their impact on patient outcomes, including advanced airway management, CPR, and therapeutic hypothermia. The review synthesizes findings from multiple studies, including a nationwide population-based study, randomized controlled trials, and investigations on pre-hospital cooling. The results highlight the importance of paramedics in providing timely and effective emergency care, with studies indicating improved neurological outcomes and survival rates following paramedic arrival. However, the review also notes mixed results regarding the impact of specific interventions, such as therapeutic hypothermia, indicating the need for further research and refinement of paramedic protocols to enhance patient care during cardiac arrest. The review concludes that paramedics play a crucial role in restoring circulation and breathing through CPR, resuscitation, and hypothermia, which is closely related to other healthcare positions.

Running head: LITERATURE REVIEW
Literature review on scope of paramedic practice related to cardiac arrest
Name of the Student
Name of the University
Author Note

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Introduction
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.
Methods
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:
Parameters Elements
P (Problem) Cardiac arrest
I (Intervention) Paramedic services

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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.
Results
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.

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Discussion
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

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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).
Conclusion
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

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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.

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References
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ethnography of work culture and occupational identity. Emerg Med J. 2015 May
1;32(5):e6-7.
2) 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.
3) Hastings C, Fisher CA. Searching for proof: Creating and using an actionable PICO
question. Nursing management. 2014 Aug 1;45(8):9-12.
4) 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.
5) 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.
6) 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.
7) 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.

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8) 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.
9) 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.