Paramedic Papers Daily — 8 October 2026

Seven new papers today — here are the top four. Paper one — amiodarone looks worthwhile when a non-shockable rhythm converts to shockable. Paper two — long resuscitations don't rule out a good recovery. Paper three — family CPR helps, but a stranger's CPR helps more. Paper four — bystander AEDs work, but almost nobody grabs one.

Paper one — Resuscitation. A propensity-score-matched registry cohort from Germany, five thousand five hundred and thirty-five adults whose out-of-hospital cardiac arrest started non-shockable and later converted to a shockable rhythm. After matching one thousand eight hundred and forty-three pairs, amiodarone was associated with more admissions with return of spontaneous circulation — twenty-six point seven versus twenty-three per cent — better twenty-four-hour survival, twenty-one point four versus fourteen point seven per cent, and better survival to discharge, six point five versus four point two per cent. Favourable neurological outcome, though, didn't reach statistical significance. It's retrospective registry data, so this is association rather than proof. Amiodarone is standard kit in Australian arrest care, so the finding lands squarely in scope — the question the authors want answered next is timing, and whether giving it earlier does better.

Paper two — also Resuscitation. Danish registry data on two thousand five hundred and eighty-three bystander-witnessed cardiac arrest survivors, split by time to return of spontaneous circulation — under ten minutes, eleven to eighteen, and over eighteen. Anoxic brain damage did climb with time — nought point three, one point eight and three point two per cent across those groups. But five-year survival was about seventy-nine per cent in every group, return to work about sixty per cent, and nursing-home admission didn't differ either. The catch — only patients alive at thirty days were included, so this says nothing about whether longer efforts save more people overall. What it does say is that a long resuscitation doesn't preclude a good recovery, which is exactly the reassurance a crew working a prolonged arrest needs.

Paper three — Resuscitation Plus. A United States registry cohort, nearly eight hundred and twenty-five thousand out-of-hospital arrests between twenty-thirteen and twenty-twenty-four. Survival to discharge was seven point three per cent with no bystander CPR, nine point six per cent when a family member started compressions, and seventeen point three per cent when a bystander outside the family did. Non-family CPR also beat family CPR head-to-head, with the same pattern for good neurological survival. Who witnesses an arrest is tangled up with the arrest itself, so the gap may be partly confounded. Still — most arrests happen at home in front of family, and the space between who's present and who does effective CPR is a community training problem right across Australia.

Paper four — Prehospital Emergency Care. A Korean multicentre registry, twenty-three thousand nine hundred and eighteen arrests, with just three hundred and eighty-three bystander AED applications in nearly a decade. When a bystander did apply one, survival was better — an adjusted odds ratio of one point six — and good neurological outcome better still at two point three, comparable to a paramedic-delivered shock. But AEDs were applied in only eight point five per cent of public-area opportunities, and under two per cent where the arrest happened at home. The devices work — the deployment gap is the problem, and it's the same gap Australian public-access programs wrestle with. Caveat — with so few AED cases, the estimates are imprecise and system-specific.

Quick recap. One — amiodarone was linked to better survival after non-shockable-to-shockable conversion, though not clearly better neurology. Two — brain injury rises with longer arrests, but five-year survival and return to work don't. Three — family CPR beats none, strangers' CPR beats family. Four — bystander AEDs match paramedic shocks when someone actually grabs one.

Also on the dashboard today — global bystander CPR rates, blood pressure centiles for sick kids, and a defibrillation trial just getting underway. That's the roundup for Thursday the eighth of October. Back tomorrow.