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

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

doi:10.33963/kp.a2022.0109

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…With the current level of training of the paramedics of a Franco-German EMS system [25], a tele-EMS system offers advantages over a pure paramedic system even if some publications show no advantage in terms of non-life-threatening missions [26]. Notwithstanding that sufficient randomised controlled trials regarding prehospital treatment of physicians and paramedics are not yet available, some publications show advantages for the care of the rarely occurring life-threatening missions by EMS physicians [27,28].…”

Section: Discussionmentioning

confidence: 99%

Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial

et al. 2023

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Background A tele-emergency medical service with a remote emergency physician for severe prehospital emergencies may overcome the increasing number of emergency calls and shortage of emergency medical service providers. We analysed whether routine use of a tele-emergency medical service is non-inferior to a conventional physician-based one in the occurrence of intervention-related adverse events. Methods This open-label, randomised, controlled, parallel-group, non-inferiority trial included all routine severe emergency patients aged ≥ 18 years within the ground-based ambulance service of Aachen, Germany. Patients were randomised in a 1:1 allocation ratio to receive either tele-emergency medical service (n = 1764) or conventional physician-based emergency medical service (n = 1767). The primary outcome was the occurrence of intervention-related adverse events with suspected causality to the group assignment. The trial was registered with ClinicalTrials.gov (NCT02617875) on 30 November 2015 and is reported in accordance with the CONSORT statement for non-inferiority trials. Results Among 3531 randomised patients, 3220 were included in the primary analysis (mean age, 61.3 years; 53.8% female); 1676 were randomised to the conventional physician-based emergency medical service (control) group and 1544 to the tele-emergency medical service group. A physician was not deemed necessary in 108 of 1676 cases (6.4%) and 893 of 1544 cases (57.8%) in the control and tele-emergency medical service groups, respectively. The primary endpoint occurred only once in the tele-emergency medical service group. The Newcombe hybrid score method confirmed the non-inferiority of the tele-emergency medical service, as the non-inferiority margin of − 0.015 was not covered by the 97.5% confidence interval of − 0.0046 to 0.0025. Conclusions Among severe emergency cases, tele-emergency medical service was non-inferior to conventional physician-based emergency medical service in terms of the occurrence of adverse events.

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Section: Discussionmentioning

confidence: 99%

Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial

et al. 2023

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The Influence of the COVID-19 Pandemic on Emergency Medical Services to Out-of-Hospital Cardiac Arrests in a Low-Incidence Urban City: An Observational Epidemiological Analysis

Liu

Tsai

Hsu

et al. 2023

IJERPH

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The Emergency Medical Services (EMS) system faced overwhelming challenges during the coronavirus disease 2019 (COVID-19) pandemic. However, further information is required to determine how the pandemic affected the EMS response and the clinical outcomes of out-of-hospital cardiac arrest (OHCA) patients in COVID-19 low-incidence cities. A retrospective study was conducted in Chiayi, Taiwan, a COVID-19 low-incidence urban city. We compared the outcomes and rescue records before (2018–2019) and during (2020–2021) the COVID-19 pandemic. A total of 567 patients before and 497 during the pandemic were enrolled. Multivariate analysis revealed that the COVID-19 pandemic had no significant influence on the achievement of return of spontaneous circulation (ROSC) and sustained ROSC but was associated with lower probabilities of survival to discharge (aOR = 0.43, 95% CI: 0.21–0.89, p = 0.002) and discharge with favorable neurologic outcome among OHCA patients (aOR = 0.35, 95% CI: 0.16–0.77, p = 0.009). Patients’ ages and OHCA locations were also discovered to be independently related to survival results. The overall impact of longer EMS rescue times on survival outcomes during the pandemic was not significant, with an exception of the specific group that experienced prolonged rescue times (total EMS time > 21 min).

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Long-term prognosis of out-of-hospital cardiac arrest due to idiopathic ventricular arrhythmias

Pinto

Proença

Carvalho

et al. 2023

Monaldi Arch Chest Dis

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Life-threatening ventricular arrhythmias (VA) may occur in patients with unknown cardiac disease. A sizable part of them remains labeled as Idiopathic VA and limited data is available regarding their natural history. Our aim was to evaluate the long-term clinical outcomes of survivors of an idiopathic life-threatening VA. Patients who survived an idiopathic life-threatening VA referred to an ICD were included and followed for a median follow-up of 7 years. Clinical and device data were collected and a comparison between genders was made. A total of 29 patients, 41% female, mean age of 50 (19) years were studied; all were implanted with an ICD at index hospitalization. At follow-up, an etiological diagnosis was established in 38% of patients. Genetic testing improved the diagnosis and allowed the identification of a distinct clinical entity in 60% of patients (p=0.04, OR = 7.0), especially in women. Regarding ICD data, 31% received appropriate therapies with a median time to first appropriate shock of 39 months (IQR 12-46 months). Men had a significantly higher prevalence of appropriated shocks (50% vs 8%, p=0.04), with a similar time to the first arrhythmic event between genders. Two of the patients died, both from non-arrhythmic causes. Etiologic diagnosis and recurrence prediction in patients with idiopathic VA is challenging, even with long-term follow-up and sophisticated diagnostic evaluation. Genetic testing significantly improved the diagnostic yield, especially in women. Arrhythmia recurrence occurred in about one-third of patients and is significantly higher in men, underscoring the importance of ICD implantation.

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

Cited by 3 publications

References 28 publications

Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial

Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial

The Influence of the COVID-19 Pandemic on Emergency Medical Services to Out-of-Hospital Cardiac Arrests in a Low-Incidence Urban City: An Observational Epidemiological Analysis

Long-term prognosis of out-of-hospital cardiac arrest due to idiopathic ventricular arrhythmias

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