A systematic review of controlled studies: do physicians increase survival with prehospital treatment?

Bøtker, Morten Thingemann; Bakke, Skule Arnesen; Christensen, Erika Frischknecht

doi:10.1186/1757-7241-17-12

Cited by 73 publications

(66 citation statements)

References 41 publications

(135 reference statements)

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“…Accurate triage and bypass protocols (whereby patients with major trauma are taken directly to a major trauma centre, potentially bypassing closer EDs) are therefore essential [3,46,67,68]. Helicopter transfer to definitive care has recently been demonstrated to reduce mortality from major trauma [69], but this is in addition to evidence that physicians bring survival benefits to the pre-hospital phase of trauma care [70,71].…”

Section: Pre-hospital Carementioning

confidence: 99%

Trauma system development

Lendrum

Lockey

2012

Anaesthesia

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SummaryThe word ‘trauma’ describes the disease entity resulting from physical injury. Trauma is one of the leading causes of death worldwide and deaths due to injury look set to increase. As early as the 1970s, it became evident that centralisation of resources and expertise could reduce the mortality rate from serious injury and that organisation of trauma care delivery into formal systems could improve outcome further. Internationally, trauma systems have evolved in various forms, with widespread reports of mortality and functional outcome benefits when major trauma management is delivered in this way. The management of major trauma in England is currently undergoing significant change. The London Trauma System began operating in April 2010 and others throughout England became operational this year. Similar systems exist internationally and continue to be developed. Anaesthetists have been and continue to be involved with all levels of trauma care delivery, from the provision of pre‐hospital trauma and retrieval teams, through to chronic pain management and rehabilitation of patients back into society. This review examines the international development of major trauma care delivery and the components of a modern trauma system.

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Section: Pre-hospital Carementioning

confidence: 99%

Trauma system development

Lendrum

Lockey

2012

Anaesthesia

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“…In summary, there is no existing evidence to support paramedic-delivered pre-hospital critical care for patients with OHCA, while for physician-delivered pre-hospital critical care studies have shown mixed results, 15 with the largest and most recent study failing to demonstrate any benefits. 21 Currently, all EMS in the United Kingdom (UK) dispatch ALS trained paramedics to confirmed or suspected OHCA.…”

Section: Introductionmentioning

confidence: 98%

“…14 A systematic review by Botker from 2009 examined the effect of physician-delivered pre-hospital critical care on OHCA outcomes and found a benefit, 'based on limited evidence'. 15 Small sample size, 16 comparison of pre-hospital critical care with very limited basic life support 17 and study designs which did not control for significant confounding factors [17][18][19][20] make the application and generalisation of these findings problematic.…”

Section: Introductionmentioning

confidence: 99%

The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

2015

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The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest. Resuscitation, 96. pp. 290-295. ISSN 0300-9572 Available from: http://eprints.uwe.ac.uk/29457We recommend you cite the published version. The publisher's URL is: http://dx.doi.org/10.1016/j.resuscitation.2015.08.020Refereed: Yes (no note) Disclaimer UWE has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material. UWE makes no representation or warranties of commercial utility, title, or fitness for a particular purpose or any other warranty, express or implied in respect of any material deposited. UWE makes no representation that the use of the materials will not infringe any patent, copyright, trademark or other property or proprietary rights. UWE accepts no liability for any infringement of intellectual property rights in any material deposited but will remove such material from public view pending investigation in the event of an allegation of any such infringement. PLEASE SCROLL DOWN FOR TEXT.The Impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest 1 THE IMPACT OF A PRE-HOSPITAL CRITICAL CARE TEAM ON SURVIVAL FROM OUT-OF- WORD COUNT, REFERENCES, FIGURES AND TABLES Abstract: 233Manuscript: 3045 ABSTRACT AimTo assess the impact of a pre-hospital critical care team (CCT) on survival from out-ofhospital cardiac arrest (OHCA). MethodsWe undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups. The primary outcome was survival to hospital discharge. All data were collected independently of the research. Results1851 cases of OHCA were included in the analysis, of which 1686 received ALS paramedic treatment and 165 were attended by both ALS paramedics and a CCT. Unadjusted rates of survival to hospital discharge were significantly higher in the CCT group, compared to the ALS paramedic group (15.8% and 6.5%, respectively, p < 0.001). After adjustment using multiple logistic regression, the effect of CCT treatment was no longer statistically significant (OR 1.54, 95% CI 0.89 to 2.67, p = 0.13). Subgroup analysis of OHCA with first monitored rhythm of ventricular fibrillation or pulseless ventricular tachycardia showed similar results. ConclusionPre-hospital critical care for OHCA was not associated with significantly improved rates of survival to hospital discharge. These results are in keeping with previously published studies.Further research with a larger sample size is required to determine whether CCTs can improve outcome in OHCA.The Impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest 3

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“…1e4 Increase survival rate is more common in traumatic patients who received pre-hospital care. 4 For non-traumatic conditions, patients with some particular diseases have been shown to benefit from pre-hospital treatment, such as chronic obstructive pulmonary disease (COPD) or myocardial infarction. 3,4 The Thai government established the pre-hospital emergency medical service in 2008 to improve emergency medical care.…”

Section: Introductionmentioning

confidence: 99%

“…4 For non-traumatic conditions, patients with some particular diseases have been shown to benefit from pre-hospital treatment, such as chronic obstructive pulmonary disease (COPD) or myocardial infarction. 3,4 The Thai government established the pre-hospital emergency medical service in 2008 to improve emergency medical care. The patients can reach the pre-hospital medical care by calling a toll-free number (1669) which will connect them to the nearest hospital.…”

Section: Introductionmentioning

confidence: 99%

Low oxygen saturation is associated with pre-hospital mortality among non-traumatic patients using emergency medical services: A national database of Thailand

Sawanyawisuth¹

2015

Tr J Emerg Med

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a b s t r a c tBackground: Pre-hospital emergency medical services are an important network for Emergency Medicine. It has been shown to reduce morbidity and mortality of patients by medical procedures. The Thai government established pre-hospital emergency medical services in 2008 to improve emergency medical care. Since then, there are limited data at the national level on mortality rates with pre-hospital care and the risk factors associated with mortality in non-traumatic patients. Aims: To study the pre-hospital mortality rate and factors associated with mortality in non-traumatic patients using the emergency medical service in Thailand. Methods: This study retrieved medical data from the National Institute for Emergency Medicine, NIEMS. The inclusion criteria were adult patients above the age of 15 who received medical services by the emergency medical services in Thailand (except Bangkok) from April 1st, 2011 to March 31st, 2012. Patients were excluded if there was no treatment during pre-hospital period, if they were trauma patients, or if their medical data was incomplete. Patients were categorized as either in the survival or non-survival group. Factors associated with mortality were examined by multivariate logistic regression analysis. Results: During the study period, there were 127,602 non-traumatic patients who used pre-hospital emergency medical services in Thailand. Of those, 98,587 patients met the study criteria. For the statistical analyses, there were 66,760 patients who had complete clinical investigations. The mortality rate in this group was 1.89%. Only oxygen saturation was associated with mortality by multivariate logistic regression analysis. The adjusted OR was 0.922 (95% CI 0.8550.994). Conclusion: Low oxygen saturation is significantly associated with pre-hospital mortality in a national database of non-traumatic patients using emergency medical services in Thailand. During pre-hospital care, oxygen level should be monitored and promptly treated. Pulse oximetry devices should be available in all pre-hospital services.

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A systematic review of controlled studies: do physicians increase survival with prehospital treatment?

Cited by 73 publications

References 41 publications

Trauma system development

Trauma system development

The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

Low oxygen saturation is associated with pre-hospital mortality among non-traumatic patients using emergency medical services: A national database of Thailand

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