Pilot regional analysis of emergency medical services and medication efficacy in out-of-hospital cardiac arrest

Background: Out-of-hospital cardiac arrest (OHCA) remains a critical public health challenge, with survival rates influenced by regional emergency medical services (EMS) protocols. This study evaluates the impact of EMS-administered medications on return of spontaneous circulation (ROSC) in OHCA cases within the Lublin Voivodeship, Poland. Methods: A retrospective analysis of 4361 OHCA cases from 2014 to 2017 was conducted using EMS records identified through International Classification of Diseases, Tenth Revision (ICD-10) and ICD-9 codes. Statistical analyses, including chi-square tests and multivariate logistic regression, assessed the associations between medication administration and ROSC outcomes. Results: ROSC was achieved in 32.7% of cases. Epinephrine, administered in 89.06% of cases, was not significantly associated with ROSC (p = 0.425). Amiodarone, used in 18.27% of cases, was significantly associated with ROSC in shockable rhythms (p = 0.012). Sodium bicarbonate, given in 23.12%of cases, was linked to ROSC in overdose-related arrests (p = 0.034) but showed lower effectiveness outside of such cases. Dopamine, administered in 22.51% of cases, was positively correlated with ROSC (p = 0.018), as was fluid therapy, provided in 62.67%of cases (p = 0.021). Medication administration varied by incident location and etiology, with amiodarone and sodium bicarbonate more frequently used in workplace incidents, and sodium bicarbonate and fluid therapy more common in overdose-related OHCA cases. Amiodarone use was significantly higher in ventricular fibrillation/ventricular tachycardia (VF/VT) cases (p = 0.013). Conclusions: This regional study underscores the critical role of EMS-administered medications and contextual factors in OHCA outcomes. Findings suggest that targeted medication use based on initial heart rhythm and arrest etiology may enhance resuscitation success. Future multicenter or prospective studies are needed to validate these results and inform global prehospital resuscitation strategie.

Out-of-hospital cardiac arrest; Emergency medical services; Epinephrine; Amiodarone; Return of spontaneous circulation

[1] Cournoyer A, Grunau B, Cheskes S, Vaillancourt C, Segal E, de Montigny L, et al. Clinical outcomes following out-of-hospital cardiac arrest: the minute-by-minute impact of bystander cardiopulmonary resuscitation. Resuscitation. 2023; 185: 109693.

[2] Pu Y, Chai X, Yang G. Association between prehospital time and in-hospital outcomes in out-of-hospital cardiac arrests according to resuscitation outcomes consortium epidemiologic registry. Heart & Lung. 2024; 64: 168–175.

[3] Yogeswaran V, Drucker C, Kume K, Poel A, Yarid N, Leyde S, et al. Presentation and outcomes of adults with overdose-related out-of-hospital cardiac arrest. JAMA Network Open. 2023; 6: e2341921.

[4] Sambola A, Halvorsen S, Adlam D, Hassager C, Price S, Rosano G, et al. Management of cardiac emergencies in women: a clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the Heart Failure Association (HFA), and the European Heart Rhythm Association (EHRA) of the ESC, and the ESC Working Group on Cardiovascular Pharmacotherapy. European Heart Journal Open. 2024; 4: oeae011.

[5] Thygerson S, Memmott G, Chaney R. A global emergency: identifying priorities for reforming international emergency medical systems. Medical Research Archives. 2023; 11.

[6] Scholtz A, Harms HB, Neumuth T. International emergency responses: harmonizing data security and protection standards for emergency medical teams. Emergency Care and Medicine. 2024; 1: 193–198.

[7] Trochimiak P, Leszczyński PK, Świniarski P. Comparative analysis of pharmacotherapy used by emergency medical services in Poland. Critical Care Innovations. 2020; 3: 20–30.

[8] Nowak-Zając K, Domagała A, Bielska IA, Kowalska-Bobko I. New paramedic scope of practice in Poland based on the 2022 reform. Health Policy. 2024; 143: 105015.

[9] Penketh J, Nolan JP. In-hospital cardiac arrest: the state of the art. Critical Care. 2022; 26: 376.

[10] Thannhauser J, Nas J, Waalewijn RA, van Royen N, Bonnes JL, Brouwer MA, et al. Towards individualised treatment of out-of-hospital cardiac arrest patients: an update on technical innovations in the prehospital chain of survival. Netherlands Heart Journal. 2022; 30: 345–349.

[11] Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, et al. Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: a scientific statement from the International Liaison Committee on Resuscitation. Circulation. 2022; 145: e776–e801.

[12] Internetowy System Aktów Prawnych. On the profession of paramedics and the self-governing body of paramedics. 2022. Available at: https://isap.sejm.gov.pl/isap.nsf/DocDetails.xsp?id=WDU20220002705 (Accessed: 01 December 2022).

[13] Rolston DM, Li T, Owens C, Haddad G, Palmieri TJ, Blinder V, et al. Mechanical, team‐focused, video‐reviewed cardiopulmonary resuscitation improves return of spontaneous circulation after emergency department implementation. Journal of the American Heart Association. 2020; 9: e014420.

[14] Lin JJ, Huang CH, Chen WJ, Chuang PY, Chang WT, Chen WT, et al. Targeted temperature management and emergent coronary angiography are associated with improved outcomes in patients with prehospital return of spontaneous circulation. Journal of the Formosan Medical Association. 2020; 119: 1259–1266.

[15] King C, Lewinsohn A, Keeliher C, McLachlan S, Sherrin J, Khan-Cheema H, et al. Cardiovascular complications of prehospital emergency anaesthesia in patients with return of spontaneous circulation following medical cardiac arrest: a retrospective comparison of ketamine-based and midazolam-based induction protocols. Emergency Medicine Journal. 2022; 39: 672–678.

[16] Jang Y, Kim TH, Lee SY, Ro YS, Hong KJ, Song KJ, et al. Association of transport time interval with neurologic outcome in out-of-hospital cardiac arrest patients without return of spontaneous circulation on scene and the interaction effect according to prehospital airway management. Clinical and Experimental Emergency Medicine. 2022; 9: 23.

[17] Proclemer A, Grazia Bongiorni M, Etsner H, Todd D, Sciaraffia E, Blomström-Lundqvist C; Scientific Initiatives Committee, European Heart Rhythm Association. Current implantable cardioverter-defibrillator programming in Europe: the results of the European Heart Rhythm Association survey. Europace. 2014; 16: 935–938.

[18] Aves T, Chopra A, Patel M, Lin S. Epinephrine for out-of-hospital cardiac arrest: an updated systematic review and meta-analysis. Critical Care Medicine. 2020; 48: 225–229.

[19] Bornstein K, Long B, Della Porta A, Weinberg G. After a century, Epinephrine’s role in cardiac arrest resuscitation remains controversial. The American Journal of Emergency Medicine. 2021; 39: 168–172.

[20] Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, et al. 2023 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations: summary from the basic life support; advanced life support; pediatric life support; neonatal life support; education, implementation, and teams; and first aid task forces. Circulation. 2023; 148: e187–e280.

[21] Perry E, Nehme E, Stub D, Anderson D, Nehme Z. The impact of time to amiodarone administration on survival from out-of-hospital cardiac arrest. Resuscitation Plus. 2023; 14: 100405.

[22] Lavonas EJ, Akpunonu PD, Arens AM, Babu KM, Cao D, Hoffman RS, et al. 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2023; 148: e149–e184.

[23] Wingfield WE. Cardiopulmonary arrest. In Wingfield WE, Raffe MR (eds.) The Veterinary ICU Book (pp. 421–452). 1st edn. CRC Press: London. 2020.

[24] Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, et al.; Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups. Part 1: executive summary: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142: S337–S357.

[25] Cheng A, Magid DJ, Auerbach M, Bhanji F, Bigham BL, Blewer AL, et al. Part 6: resuscitation education science: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142: S551–S579.

[26] Goniewicz K, Burkle FM, Khorram-Manesh A. Transforming global public health: climate collaboration, political challenges, and systemic change. Journal of Infection and Public Health. 2025; 18: 102615.

[27] Mani ZA, Goniewicz K. Adapting disaster preparedness strategies to changing climate patterns in Saudi Arabia: a rapid review. Sustainability. 2023; 15: 14279.