Background: Survival rates from out-of-hospital cardiac arrest (OHCA) remain low, despite remarkable efforts to\nimprove care. A number of ambulance services in the United Kingdom (UK) have developed prehospital critical care\nteams (CCTs) which attend critically ill patients, including OHCA. However, current scientific evidence describing\nCCTs attending OHCA is sparse and research to date has not demonstrated clear benefits from this model of care.\nMethods: This prospective, observational study will describe the effect of CCTs on survival from OHCA, when compared\nto advanced-life-support (ALS), the current standard of prehospital care in the UK. In addition, we will describe the\nassociation between individual critical care interventions and survival, and also the costs of CCTs for OHCA.\nTo examine the effect of CCTs on survival from OHCA, we will use routine Utstein variables data already collected in a\nnumber of UK ambulance trusts. We will use propensity score matching to adjust for imbalances between the CCT and\nALS groups. The primary outcome will be survival to hospital discharge, with the secondary outcome of survival to\nhospital admission.\nWe will record the critical care interventions delivered during CCT attendance at OHCA. We will describe frequencies and\naim to use multiple logistic regression to examine possible associations with survival.\nFinally, we will undertake a stakeholder-focused cost analysis of CCTs for OHCA. This will utilise a previously published\nEmergency Medical Services (EMS) cost analysis toolkit and will take into account the costs incurred from use of a\nhelicopter and the proportion of these costs currently covered by charities in the UK.\nDiscussion: Prehospital critical care for OHCA is not universally available in many EMS. In the UK, it is variable and largely\nfunded through public donations to charities. If this study demonstrates benefit from CCTs at an acceptable cost to the\npublic or EMS commissioners, it will provide a rationale to increase funding and service provision. If no clinical benefit is\nfound, the public and charities providing these services can consider concentrating their efforts on other areas of\nprehospital care.
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