Prehospital neuromuscular blockade post OHCA: UK's first paramedic-delivered protocol. (2nd May 2020)

• Record Type: Journal Article
• Authors: Durham, Mark; Westhead, Pete; Griffiths, David; Lyon, Richard; Lau-Walker, Margaret
• Is Part Of: Journal of paramedic practice. Volume 12:Number 5(2020)
• Page Start: 202
• Page End: 207
• Publication Date: 2020-05-02
• Subjects: Prehospital -- Rocuronium -- Out-of-hospital cardiac arrest (OHCA) -- Return of spontaneous circulation (ROSC) -- Neuromuscular blockade; Emergency medicine -- Periodicals; Emergency medical technicians -- Periodicals; 616.025
• DOI: 10.12968/jpar.2020.12.5.202
• Languages: English
• ISSNs: 1759-1376

Abstract

Abstract : Background: Since 2016, critical care paramedics from the South East Coast Ambulance Service have offered neuromuscular blockade to patients for ventilatory/airway control after cardiac arrest. Aims: To examine the first cases of paramedic-delivered neuromuscular blockade, and evaluate the prevalence of its use and safety. Methods: Retrospective service evaluation of patients receiving post-arrest paralysis during the study period from 1 April 2016 until 31 July 2017. Findings: The study included 127 patients. The mean age of administration was 63 years, mean weight was 80 kg (SD: 19 kg), dose was 1 mg/kg and median time from rocuronium administration to hospital was 32 minutes (IQR 20–43 minutes). Three patients (2.3%) experienced a minor adverse incident. There were no major airway complications, nor other significant adverse incidents. Thirty-seven patients (31%) survived to discharge. Conclusion: From this patient group, paramedic-administered rocuronium in intubated patients who have experienced a cardiac arrest and a return of spontaneous circulation appears to be safe, but further interventional research is required to determine whether this improves patient outcomes.