Could giving antibiotics in the pre-hospital environment improve outcomes for patients with severe sepsis? A literature review
Posted on August 8, 2019 by Erika Winch
During the final year of their Paramedic Science (BSc Hons) course at Oxford Brookes University, students carry out a literature review and critical appraisal of a topic relevant to their future practice. This blog presents the abstract of a literature review on ‘Giving antibiotics in the pre-hospital environment for patients with severe sepsis?‘. Other Paramedic topic blogs can be found here.
The aim of this review is to explore the potential benefits of improvements to pre-hospital sepsis care, specifically to discover if the use of antibiotics for severe sepsis in the pre-hospital environment will improve patient outcomes.
This review takes the form of a good standard literature review, following a systematic approach. A systematic search was undertaken, followed by critical appraisal of the identified papers. The available research was used to highlight key themes relating to the research question.
The key themes identified included the quantity of EMS use for septic patients, disease severity, paramedic education and training, time to antibiotic administration for EMS patients, and the effect of treatment changes on patient mortality. Although there was some key evidence highlighted, overall available research was limited. It was possible to identify an increase in use of EMS for patients with worse disease severity, although EMS patients usually received antibiotics quicker than non-EMS patients. Despite this, mortality rates were not improved for these patients, even when results were adjusted for disease severity.
The available research, whilst highlighting the key themes, did not always provide clear answers to the initial question. There appears to be limited research which is completely focussed on use of antibiotics for severe sepsis in the pre-hospital environment. Whilst the evidence provided is useful to draw some conclusions, it is not of the strength that would be required to change best practices within the paramedic profession.
Further research is required before definitive conclusions can be drawn. Research must provide clear evidence that patient outcomes can be improved before a change of practice can be recommended. Additional research must be primarily focussed on the use of antibiotics in the pre-hospital setting.
Reviewed Paper References:
1. Alam, N., Oskam, E., Stassen, P., van Exter, P., van de Ven, P., Haak, H., Holleman, F., van Zanten, A., van Leeuwen-Nguyen, H., Bon, V., Duineveld, B., Nannan Panday, R., Kramer, M., Nanayakkara, P. (2018). Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Lancet Respiratory Medicine. 6 (1), 40-50.
2. Andersson, H., Axelsson, C., Larsson, A., Bremer, A., Gellerstedt, M., Bång, A., Herlitz, J., Ljungström, l. (2018). The early chain of care in bacteraemia patients: Early suspicion, treatment and survival in prehospital emergency care. American Journal of Emergency Medicine. 36(12):2211-2218.
3. Band, R., Gaieski, D., Hylton, J., Shofer, F., Goyal, M., Meisel, Z. (2011). Arriving by Emergency Medical Services Improves Time to Treatment Endpoints for Patients with Severe Sepsis or Septic Shock. Academic Emergency Medicine. 18 (9), 934-940.
4. Chippendale, J., Lloyd, A., Payne, T., Dunmore, S., Stoddart, B. (2018). The feasibility of paramedics delivering antibiotic treatment pre-hospital to ‘red flag’ sepsis patients: a service evaluation. British Paramedic Journal. 2 (4), 19-24.
5. Herlitz, J., Bång, A., Wireklint-Sundström, B., Axelsson, C., Bremer, A., Hagiwara, M., Jonsson, A., Lundberg, L., Suserud, B., Ljungström, L. (2012). Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 27 (20), 42.
6. Pike, J., Wood, B., John Pike, Theminimulle, S., Lawal-Rieley, T., Ballington, J., Moody, S., Andrews, R. (2015). Can paramedics treat sepsis? Journal of Paramedic Practice. 7 (9), 454-458.
7. Seymour, C., Kahn, J., Martin-Gill, C., Callaway, C., Yealy, D., Scales, D., Angus, C. (2017). Delays from First Medical Contact to Antibiotic Administration for Sepsis. Critical Care Medicine. 45 (5), 759-765.
8. Studnek, J., Artho, M., Garner, C., Jones, A. (2012). The Impact of Emergency Medical Services on the Emergency Department Care of Severe Sepsis. American Journal of Emergency Medicine. 30 (1), 51-56.
9. Walchok, J., Pirrallo, R., Furmanek, D., Lutz, M., Shope, C., Giles, B., Gue, G., Dix, A. (2017). Paramedic-Initiated CMS Sepsis Core Measure Bundle Prior to Hospital Arrival: A Stepwise Approach. Pre-hospital Emergency Care. 21 (3), 291-300.
10. Wang, H., Weaver, M., Shapiro, N., Yealy, S. (2010). Opportunities for Emergency Medical Services Care of Sepsis. Resuscitation. 81 (2), 193-197.