Strategies to improve out-of-hospital cardiac arrest outcomes in the pre-hospital environment – Part B: non-pharmaceutical strategies


heart arrest
emergency medical service
advanced life support

How to Cite

Pemberton KE, Franklin RC, Watt K. Strategies to improve out-of-hospital cardiac arrest outcomes in the pre-hospital environment – Part B: non-pharmaceutical strategies. Australasian Journal of Paramedicine [Internet]. 2019Nov.4 [cited 2022Jul.3];160. Available from:



Out-of-hospital cardiac arrest (OHCA) historically has low survival rates. Higher rates of survival have recently developed in some small geographical areas, which pre-empted an increase in the volume of research in this field. The aim of this paper is to consolidate the findings of the strategies that do not focus on drugs.


This is a systematic search and review, rather than a systematic review. A search of four databases (MEDLINE, CINAHL, Informit, Scopus) was undertaken in February 2017. Papers published between 2007 and 2017 containing strategies that may be used by paramedics when resuscitating adult patients in OHCA from presumed cardiac aetiology were identified.


Twenty-eight studies were included in the review, comprising six separate strategies. This manuscript reports on the four non-pharmaceutical strategies (use of a modified resuscitation protocol; use of a mechanical chest compression device; intra-thoracic pressure regulation and application of therapeutic hypothermia).


Use of a modified resuscitation protocol to improve the quality of cardiopulmonary resuscitation, was the only strategy showing evidence to warrant a recommendation for immediate implementation. Future studies should focus on strategy specific patient subsets.


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