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Does the presence of physician-staffed emergency medical service improve the prognosis in out-of-hospital cardiac arrest? A propensity score matching analysis

Kamil Bujak1, Klaudiusz Nadolny23, Przemysław Trzeciak1, Robert Gałązkowski4, Jerzy Robert Ładny5, Mariusz Gąsior1
DOI: 10.33963/KP.a2022.0109
·
Pubmed: 35445741
Affiliations
  1. 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
  2. Faculty of Medicine, Katowice School of Technology, Katowice, Poland
  3. Departament of Health Sciences, WSB University, Dąbrowa Górnicza, Poland
  4. Department of Emergency Medical Service, Medical University of Warsaw, Warszawa, Poland
  5. Department of Emergency Medicine, Medical University of Bialystok, Białystok, Poland

open access

Online first
Original article
Published online: 2022-04-21

Abstract

BACKGROUND: Substantial differences in survival after out-of-hospital cardiac arrest (OHCA) have been observed between countries. These might be attributed to the organization of Emergency Medical Service (EMS) systems, including prehospital physician involvement. However, limited data exist on the physician's role in survival after OHCA.

AIMS: To compare prehospital and in-hospital outcomes of OHCA patients attended by physician-staffed EMS versus paramedic-staffed EMS units.

METHODS: Among all patients enrolled in the regional, prospective registry of OHCA in southern Poland, those aged <18, with unwitnessed or EMS-witnessed cardiac arrest, without attempted cardiopulmonary resuscitation (CPR), attended by more than one EMS, or with traumatic cardiac arrest, were excluded. The groups were matched 1:1 using propensity scores for baseline characteristics variables that might influence physician-staffed EMS dispatch.

RESULTS: A total of 812 OHCA cases were included in the current analysis. Among them, 351 patients were attended by physician-staffed EMS. There were no differences in baseline characteristics in the propensity-score matched cohort consisting of 351 pairs. The return of spontaneous circulation (ROSC) was more often achieved in the physician-staffed EMS group (42.7% vs. 33.3%; P = 0.01). The prehospital survival rate was also higher in this group (34.1% vs. 19.2%; P <0.01). However, there were no significant differences in survival rate to discharge between cases treated by physician-staffed and paramedic-staffed EMS (9.7% vs. 7.0%; P = 0.22).

CONCLUSIONS: OHCA patients attended by physician-staffed EMS were more likely to have ROSC and survive to hospital admission. However, better prehospital outcomes might not translate into improved in-hospital prognosis in these patients.

Abstract

BACKGROUND: Substantial differences in survival after out-of-hospital cardiac arrest (OHCA) have been observed between countries. These might be attributed to the organization of Emergency Medical Service (EMS) systems, including prehospital physician involvement. However, limited data exist on the physician's role in survival after OHCA.

AIMS: To compare prehospital and in-hospital outcomes of OHCA patients attended by physician-staffed EMS versus paramedic-staffed EMS units.

METHODS: Among all patients enrolled in the regional, prospective registry of OHCA in southern Poland, those aged <18, with unwitnessed or EMS-witnessed cardiac arrest, without attempted cardiopulmonary resuscitation (CPR), attended by more than one EMS, or with traumatic cardiac arrest, were excluded. The groups were matched 1:1 using propensity scores for baseline characteristics variables that might influence physician-staffed EMS dispatch.

RESULTS: A total of 812 OHCA cases were included in the current analysis. Among them, 351 patients were attended by physician-staffed EMS. There were no differences in baseline characteristics in the propensity-score matched cohort consisting of 351 pairs. The return of spontaneous circulation (ROSC) was more often achieved in the physician-staffed EMS group (42.7% vs. 33.3%; P = 0.01). The prehospital survival rate was also higher in this group (34.1% vs. 19.2%; P <0.01). However, there were no significant differences in survival rate to discharge between cases treated by physician-staffed and paramedic-staffed EMS (9.7% vs. 7.0%; P = 0.22).

CONCLUSIONS: OHCA patients attended by physician-staffed EMS were more likely to have ROSC and survive to hospital admission. However, better prehospital outcomes might not translate into improved in-hospital prognosis in these patients.

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Keywords

cardiopulmonary resuscitation, emergency medical service, out-of-hospital cardiac arrest, paramedic, physician

About this article
Title

Does the presence of physician-staffed emergency medical service improve the prognosis in out-of-hospital cardiac arrest? A propensity score matching analysis

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-04-21

Page views

28

Article views/downloads

44

DOI

10.33963/KP.a2022.0109

Pubmed

35445741

Keywords

cardiopulmonary resuscitation
emergency medical service
out-of-hospital cardiac arrest
paramedic
physician

Authors

Kamil Bujak
Klaudiusz Nadolny
Przemysław Trzeciak
Robert Gałązkowski
Jerzy Robert Ładny
Mariusz Gąsior

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