open access
Does the presence of physician-staffed emergency medical service improve the prognosis in out-of-hospital cardiac arrest? A propensity score matching analysis
Affiliations- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Faculty of Medicine, Katowice School of Technology, Katowice, Poland
- Departament of Health Sciences, WSB University, Dąbrowa Górnicza, Poland
- Department of Emergency Medical Service, Medical University of Warsaw, Warszawa, Poland
- Department of Emergency Medicine, Medical University of Bialystok, Białystok, Poland
open access
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.
Keywords
cardiopulmonary resuscitation, emergency medical service, out-of-hospital cardiac arrest, paramedic, physician
About this articleTitle
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
Article type
Original article
Published online
2022-04-21
Page views
28
Article views/downloads
44
DOI
10.33963/KP.a2022.0109
Pubmed
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
References (28)- Yan S, Gan Y, Jiang N, et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020; 24(1): 61.
- Nadolny K, Zyśko D, Obremska M, et al. Analysis of out-of-hospital cardiac arrest in Poland in a 1-year period: data from the POL-OHCA registry. Kardiol Pol. 2020; 78(5): 404–411.
- Hamilton A, Steinmetz J, Wissenberg M, et al. Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest: A Danish nationwide observational study. Resuscitation. 2016; 108: 95–101.
- Ro YS, Shin SDo, Kitamura T, et al. Temporal trends in out-of-hospital cardiac arrest survival outcomes between two metropolitan communities: Seoul-Osaka resuscitation study. BMJ Open. 2015; 5(6): e007626.
- Buick JE, Drennan IR, Scales DC, et al. Improving temporal trends in survival and neurological outcomes after out-of-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes. 2018; 11(1): e003561.
- Gräsner JT, Wnent J, Herlitz J, et al. Survival after out-of-hospital cardiac arrest in Europe — Results of the EuReCa TWO study. Resuscitation. 2020; 148: 218–226.
- Sato N, Matsuyama T, Akazawa K, et al. Benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest: a community-based, observational study in Niigata, Japan. BMJ Open. 2019; 9(11): e032967.
- Hagihara A, Hasegawa M, Abe T, et al. Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest: a prospective cohort analysis. PLoS One. 2014; 9(1): e84424.
- Böttiger BW, Bernhard M, Knapp J, et al. Influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation: systematic review and meta-analysis. Crit Care. 2016; 20: 4.
- von Vopelius-Feldt J, Benger JR. Should physicians attend out-of-hospital cardiac arrests? Resuscitation. 2016; 108: A6–A7.
- Fukuda T, Ohashi-Fukuda N, Kondo Y, et al. Association of prehospital advanced life support by physician with survival after out-of-hospital cardiac arrest with blunt trauma following traffic collisions: japanese registry-based study. JAMA Surg. 2018; 153(6): e180674.
- Jackson RJH, Nolan JP. Improving outcome in out-of-hospital cardiac arrest: impact of bystander cardiopulmonary resuscitation and prehospital physician care. Crit Care. 2011; 15(1): 101.
- Estner HL, Günzel C, Ndrepepa G, et al. Outcome after out-of-hospital cardiac arrest in a physician-staffed emergency medical system according to the Utstein style. Am Heart J. 2007; 153(5): 792–799.
- Perkins G, Jacobs I, Nadkarni V, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry templates for out-of-hospital cardiac arrest. Resuscitation. 2015; 96: 328–340.
- Nadolny K, Bujak K, Kucap M, et al. The Silesian Registry of Out-of-Hospital Cardiac Arrest: Study design and results of a three-month pilot study. Cardiol J. 2020; 27(5): 566–574.
- Bujak K, Nadolny K, Ładny JR, et al. Epidemiology, management, and survival rate of out-of-hospital cardiac arrest in Upper Silesia, Poland: an Utstein-style report. Postepy Kardiol Interwencyjnej. 2021; 17(4): 366–375.
- Nadolny K, Bujak K, Obremska M, et al. Glasgow Coma Scale score of more than four on admission predicts in-hospital survival in patients after out-of-hospital cardiac arrest. Am J Emerg Med. 2021; 42: 90–94.
- Monsieurs KG, Nolan JP, Bossaert LL, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation. 2015; 95: 1–80.
- Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021; 161(4): 115–151.
- Gräsner JT, Lefering R, Koster RW, et al. EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe. Resuscitation. 2016; 105: 188–195.
- Borowicz A, Nadolny K, Bujak K, et al. Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction. Cardiol J. 2021; 28(1): 110–117.
- Yasunaga H, Horiguchi H, Tanabe S, et al. Collaborative effects of bystander-initiated cardiopulmonary resuscitation and prehospital advanced cardiac life support by physicians on survival of out-of-hospital cardiac arrest: a nationwide population-based observational study. Crit Care. 2010; 14(6): R199.
- Schewe JC, Kappler J, Heister U, et al. Outcome of out-of-hospital cardiac arrest over a period of 15 years in comparison to the RACA score in a physician staffed urban emergency medical service in Germany. Resuscitation. 2015; 96: 232–238.
- Yen ZS, Chen YT, Ko PCI, et al. Cost-effectiveness of different advanced life support providers for victims of out-of-hospital cardiac arrests. J Formos Med Assoc. 2006; 105(12): 1001–1007.
- Goto Y, Funada A, Goto Y. Impact of prehospital physician-led cardiopulmonary resuscitation on neurologically intact survival after out-of-hospital cardiac arrest: A nationwide population-based observational study. Resuscitation. 2019; 136: 38–46.
- Wang HE, Benger JR. Endotracheal intubation during out-of-hospital cardiac arrest: New insights from recent clinical trials. J Am Coll Emerg Physicians Open. 2020; 1(1): 24–29.
- Martin-Gill C, Guyette FX, Rittenberger JC. Effect of crew size on objective measures of resuscitation for out-of-hospital cardiac arrest. Prehosp Emerg Care. 2010; 14(2): 229–234.
- Tsai BM, Sun JT, Hsieh MJ, et al. Correction: Optimal paramedic numbers in resuscitation of patients with out-of-hospital cardiac arrest: A randomized controlled study in a simulation setting. PLoS One. 2020; 15(12): e0244400.
