Initial Presenting Cardiac Arrest Rhythms and Paramedic Preceptor Decisions to Intubate

Introduction—In cardiac arrest patients, anecdotal evidence suggests that paramedic preceptors encourage their students to perform high-risk procedures, such as advanced airway management (ETI), in situations when the outcome is less likely to be successful. This study attempted to determine whether the presenting rhythm of a patient found in cardiac arrest influences the preceptor’s decision to allow the student to perform endotracheal intubation.

Hypothesis—Paramedic students are performing more ETI attempts on patients found in asystole as compared to ventricular fibrillation (VF) or ventricular tachycardia (VT).

Methods—Data were analyzed from January 1, 1999 to February 13, 2017 from Fisdap, an online database for EMS and healthcare education. Criteria for inclusion were: 18 years and older, presented in nontraumatic cardiac arrest, and an initial electrical rhythm of asystole, VF or VT in which ETI was attempted. SPSS was used for statistical analysis.

Results—In all, 11,201 patients met inclusion criteria for this study. ETI was attempted in a statistically higher percentage of cases in which the patient was found in an initial rhythm of VT (66.0% of cases) in comparison to both v-fib (59.2% of cases, p = 0.002) and asystole (55.0% of cases, p = 0.001). The percentage of patients intubated by students is statistically significantly higher for VT (70.7%) than for both asystole (64.9%, p=0.002) and VF (63.0%, p=0.005). There were no statistically significant differences between asystole and v-fib with respect to ETI.

Conclusion—ETI is more likely to be performed on cardiac arrest patients presenting in VT as opposed to asystole or VF. The paramedic student is more likely to perform the intubation intervention (rather than the preceptor) when an adult patient presents in VT. The theory for this study could not be proven.