Australasian paramedic clinical practice guidelines for managing cardiac arrest: An appraisal

Abstract

Introduction There are 10 government-regulated ambulance services (paramedic provider services) in Australasia who are members of the Council of Ambulance Authorities (CAA). These CAA-member services each produce clinical practice guidelines (CPGs), which guide the practice of their paramedics. Common to each set of CAA-member CPG is a guideline that addresses cardiac arrest due to ventricular fibrillation and pulseless ventricular tachycardia (pulseless VT/VF). This study sought to answer the question: ‘Are current CAA-member CPGs developed with sufficient methodological rigour to consistently produce guidelines that, according to validated, evidence-based best practices, can be recommended for clinical use?’ Methods This question was addressed by performing a comparison of existing CAA-member CPGs for pulseless VT/VF against the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. All CPGs were anonymised and sent to each appraiser along with the AGREE II appraisal sheet. Appraisals were conducted independently for each CPG and returned to the lead author for collation. The anonymised results were then shared among all appraisers for consideration and discussion. Appraisers were free to change their appraisal after considering the comments from the other appraisers, and results were then converted into a final percent score for each CPG in accord with the recommended AGREE II instrument methodology. One appraisal question, in addition to the AGREE II criteria was added to each appraisal; the response to this was analysed separately. Results Nine CPGs were evaluated according to the AGREE II instrument. The appraisers gave passing marks to only two of the six domains in the AGREE II instrument: Domain 1 – Scope and Purpose (73%), and Domain 4 – Clarity of Presentation (74%). Less than passing marks were awarded for Domain 2 – Stakeholder Involvement (27%). Scores of less than 10% were awarded for Domain 5 – Applicability (8%) and Editorial Independence (1%). Conclusion Based on the findings of this paper, the authors conclude that it cannot be assumed that current CAA-member paramedic CPGs are developed with sufficient methodological rigour to consistently produce guidelines that, according to validated, evidence-based best practices can be recommended for clinical use. However, most of the authors agree that the CPGs reviewed could be recommended for clinical use with relatively minor modifications. It would be useful to determine whether end users of the CAA-member CPGs agree on the importance of characteristics of CPGs that the AGREE II instrument appraises.