Physician Presence in an Ambulance Car Is Associated with Increased Survival in Out-of-Hospital Cardiac Arrest: A Prospective Cohort Analysis

Abstract

The presence of a physician seems to be beneficial for pre-hospital cardiopulmonary resuscitation (CPR) of patients with out-of-hospital cardiac arrest. However, the effectiveness of a physician's presence during CPR before hospital arrival has not been established. We conducted a prospective, non-randomized, observational study using national data from out-of-hospital cardiac arrests between 2005 and 2010 in Japan. We performed a propensity analysis and examined the association between a physician's presence during an ambulance car ride and short- and long-term survival from out-of-hospital cardiac arrest. Specifically, a full non-parsimonious logistic regression model was fitted with the physician presence in the ambulance as the dependent variable; the independent variables included all study variables except for endpoint variables plus dummy variables for the 47 prefectures in Japan (i.e., 46 variables). In total, 619,928 out-of-hospital cardiac arrest cases that met the inclusion criteria were analyzed. Among propensity-matched patients, a positive association was observed between a physician's presence during an ambulance car ride and return of spontaneous circulation (ROSC) before hospital arrival, 1-month survival, and 1-month survival with minimal neurological or physical impairment (ROSC: OR = 1.84, 95% CI 1.63–2.07, p = 0.00 in adjusted for propensity and all covariates); 1-month survival: OR = 1.29, 95% CI 1.04–1.61, p = 0.02 in adjusted for propensity and all covariates); cerebral performance category (1 or 2): OR = 1.54, 95% CI 1.03–2.29, p = 0.04 in adjusted for propensity and all covariates); and overall performance category (1 or 2): OR = 1.50, 95% CI 1.01–2.24, p = 0.05 in adjusted for propensity and all covariates). A prospective observational study using national data from out-of-hospital cardiac arrests shows that a physician's presence during an ambulance car ride was independently associated with increased short- and long-term survival.

The present and future of cardiac arrest care: international experts reach out to caregivers and healthcare authorities

“…In many parts of the world, ALS ambulances are also staffed with a physician specialist in emergency medicine. One study that used propensity analysis documented that the presence of a physician on the ambulance was associated with better short-and long-term outcome after OHCA [31], but other studies have failed to show benefit for prehospital physicians [32]. The findings of a recent systematic review were consistent with this benefit and suggested that physician-guided resuscitation may improve survival outcomes after OHCA [33], but the cost-effectiveness of this policy is controversial.…”

Potential association of bystander–patient relationship with bystander response and patient survival in daytime out-of-hospital cardiac arrest

“…Of 175,912 bystander-witnessed OHCA patients transported to hospital, any physician involvement in the prehospital setting was recorded in 30,619 and unknown in 86. We first excluded these cases because CPR quality and OHCA outcomes is reported to be affected by physician involvement [12,13]. The bystander-patient relationship was unknown in 160, DA-CPR instruction and/or CPR type (chest compression-only or conventional) were unknown in 2,751, and other fundamental data for time factors and/or survival were unknown in 3,031.…”

Prehospital critical care for out-of-hospital cardiac arrest: An observational study examining survival and a stakeholder-focused cost analysis

“…The disadvantages of using this outcome are the resources required to record it as well as loss of patients to follow up. In addition, patients with long term survival will have spent minutes in the EMS, followed by days in hospital, which raises the issue of differences in hospital treatment confounding results [33, 34]. As a pragmatic approach, we chose survival to hospital discharge as the primary outcome, and survival to hospital admission as a secondary outcome.…”