Prehospital treatment of symptomatic bradycardia: A retrospective observational study

Introduction Health inequities in rural and regional areas highlight the need to understand prehospital care for time-critical conditions. Despite the significance of symptomatic bradycardia, limited research exists on its management in prehospital settings, particularly outside metropolitan centres. Therefore, the purpose of this study is to examine how symptomatic bradycardia is managed in the prehospital environment. Methods A retrospective observational analysis was conducted on adult patient data (aged 18 years and older) with clinically significant symptomatic bradycardia as attended by Queensland Ambulance Service paramedics in 2023. Cases were identified from electronic Ambulance Report Forms. Demographic, clinical, and treatment data encompassing the use of atropine, transcutaneous pacing (TCP), and adrenaline were extracted. Comparisons in geolocation, ambulance response time, intervention, and clinical outcomes were conducted using descriptive and inferential statistics. Results A total of 2418 bradycardia cases were included with a median age of 77 years (IQR 65 to 84), and 58.1% were male. Atropine was administered in 18.0% of cases (n = 436), while adrenaline was administered in 5.8% of cases (n = 140). TCP was performed in 10.1% of atropine cases (n = 44). Heart rate increased following prehospital treatment, rising from a median of 40 beats per minute (IQR 34 to 48) to 60 beats per minute (IQR 45 to 76) after treatment. Critical Care Paramedics attended 38.8% of metropolitan bradycardia cases compared with 21.4% in remote regions. Ambulance response time was shorter in remote areas, with a median of 14.8 min (IQR 7.8 to 28.1) compared with metropolitan areas at 18.2 min (IQR 11.1 to 29.5), (H = 58.228, p < 0.0001). However, the time interval from call received to atropine administration was longer in remote areas, with a median of 67.6 min (IQR 45.9 to 122.9) compared with 51.3 min (IQR 40.3 to 61.9) in metropolitan regions (H = 11.125, p < 0.01). Conclusion Prehospital treatment of symptomatic bradycardia was shown to increase heart rate. However, geolocational differences in the time interval for the advanced treatment option of atropine were observed. Further research is required to corroborate these findings and inform strategies to address geolocational-based disparities in prehospital cardiac care.