Key result
Review highlights the lack of pre-hospital guidance for new-onset AF and explores paramedic-administered amiodarone.
Why the study?
Does amiodarone administered by paramedics provide safe and effective treatment for new-onset atrial fibrillation in the pre-hospital setting?
Does amiodarone administered by paramedics provide safe and effective treatment for new-onset atrial fibrillation in the pre-hospital setting?
This review highlights the gap in current clinical guidelines for the pre-hospital management of new-onset atrial fibrillation and explores the potential role of paramedic-administered amiodarone.
Lack of pre-hospital AF guidance warrants clinical caution; prospective trials needed to assess paramedic amiodarone safety and efficacy.
Incidence of atrial fibrillation (AF) is high, it is the most prevalent arrhythmia in the UK, Europe and the USA ( Naccarelli et al, 2009 ; Davis et al, 2012 ; Dagres et al, 2013 ) and is associated with significant morbidity, high risk of stroke and mortality ( Cottrell, 2012 ). Clinical guidance from the National Collaborating Centre for Chronic Conditions (NCCCC) (2006) and the National Institute for Health and Care Excellence (NICE) (2006) supports clinicians working in primary and hospital-based emergency care, but not those working in pre-hospital care. Updated guidance from NICE (2014) highlights the importance of providing rapid, personalised, evidence-based care, yet does not provide any guidance for pre-hospital clinicians responding to emergency presentations of AF. Paramedics have knowledge and experience of identifying AF, possess antiarrhythmic, anticoagulant and anti-platelet medications as part of their formulary and possess the necessary skills for obtaining intravenous access. This article reviews the national guidance and available best-evidence to provide safe treatment to patients presenting with new-onset AF and considers areas that merit further research.
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Philip J. Brown (2014) conducted a review in Atrial fibrillation. Amiodarone was evaluated. This review highlights the lack of pre-hospital clinical guidance for new-onset atrial fibrillation and explores the potential for paramedics to administer treatments such as amiodarone.
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