Strategies to improve out-of-hospital cardiac arrest outcomes in the pre-hospital environment – Part A: pharmaceutical strategies

Historically, survival rates from out-of-hospital cardiac arrest (OHCA) have been low. In recent times, survival rates have increased substantially in some small population pockets, which sparked general interest in this field and the volume of research increased. Included was an increase in the number of strategies being investigated to improve outcomes. The aim of this review is to assemble these strategies and consolidate the findings of the pharmaceutical strategies. Methods This is a systematic search and review, rather than a systematic review. Four databases (MEDLINE, CINAHL, Informit, Scopus) were searched for papers published between 2007 and 2017 containing strategies that may be used by paramedics when resuscitating adult (18+ years) patients in cardiac arrest from presumed cardiac aetiology in the out-of-hospital environment. The search was undertaken in February 2017. Five separate search concepts were used on all databases. Each concept consisted of multiple search terms. Results This review identified 28 separate studies for final review, which formulated six strategies. These were: use of a modified resuscitation protocol; use of a mechanical chest compression device; intra-thoracic pressure regulation; vasopressin administration; thrombolysis administration; application of therapeutic hypothermia. This paper reports on the full results of the pharmaceutical strategies (vasopressin or thrombolysis administration). Part B will address the non-pharmaceutical strategies. Conclusion There is no evidence to support the introduction of vasopressin or thrombolysis use during OHCA. Future studies should focus on study design and specific patient subsets.