Identifying Quality Indicators for Prehospital Care Following Out-of-Hospital Cardiac Arrest: A Focused Scoping Review.

Abstract

Objectives: Out-of-hospital cardiac arrest (OHCA) has a high rate of mortality. While prehospital management of OHCA is well described, post-return of spontaneous circulation (ROSC) care in the prehospital setting is often based on in-hospital care and broadly lacks evidence-based prehospital-specific recommendations. Additionally, there are no formal standardized quality indicators to benchmark post-ROSC care in the prehospital setting. This study served to systematically identify and appraise post-ROSC documents to synthesize a set of potential quality indicators to inform the survey of a multi-stage Delphi consensus for national quality indicators for prehospital care after out-of-hospital cardiac arrest.

Methods: Following PRISMA guidelines, a systematic search was conducted across various databases for quality indicators and recommendations for prehospital care for post-ROSC following OHCA. Two reviewers performed title and abstract screening, full-text review, and quality appraisal using the Mixed Methods Appraisal Tool (MMAT) independently and in duplicate. Identified quality indicators and recommendations were extracted as potential quality indicators and categorized into functional domains by the research team.

Results: The search yielded 337 initial records, of which 87 underwent full-text review, and 46 studies met the a priori inclusion criteria. Studies from over 17 different countries were identified, of which the United States published the majority (n = 13). Randomized control trials represented the largest portion of the included studies (n = 18). The majority of study settings were in-hospital. Only five of the included studies made formal recommendations, and only two listed quality indicators. A total of 36 underwent appraisal with MMAT, of which the overall quality was generally high. A total of 16 potential quality indicators were extracted from the included studies and were grouped into five different domains.

Conclusions: This focused scoping review highlights a lack of specific prehospital post-ROSC benchmarks and quality indicators. The identified potential quality indicators provide a foundational framework for a Delphi process for expert consensus on specific and measurable quality indicators. These indicators aim to standardize prehospital post-ROSC care for OHCA for national datasets like the Cardiac Arrest Registry to Enhance Survival.