Outcome after out-of-hospital cardiac arrest in a physician-staffed emergency medical system according to the Utstein style.
BACKGROUND
Despite a large amount of data assessing outcomes of out-of-hospital cardiac arrests (OHCAs), little information is available about physician-staffed emergency medical service (EMS) systems. The aim of our study was to investigate the impact of a physician on the outcome of patients after OHCA.


METHODS
This is a prospective, observational study that included 539 consecutive patients (63.9 +/- 19.1 years old; 349 males) with OHCA in the community of Dachau (135,000 inhabitants) in whom resuscitation was attempted between January 2000 and January 2006 according to Utstein style. Patients were followed up to hospital discharge. The primary end point of the study was that the patients was discharged alive from hospital.


RESULTS
Of 412 patients with an OHCA, 180 (43.7%) were admitted to hospital, and 47 (11.4%) were discharged alive. Resuscitation was started by a physician in 117 (28.4%) patients, by a layperson in 118 (28.6%), or by an EMS personnel in 177 (43.0%). A total of 18 patients (18.6%) treated by physicians, 13 patients (8.0%) treated by EMS personnel (P = .02 vs treatment by physician), and 16 patients (16.5%) resuscitated by laypersons were discharged from hospital (P = .8 vs treatment by physician). In 105 patients with bystander-witnessed OHCA of cardiac origin with shockable rhythm, the discharge rate was 32.4% (n = 34). Multivariate analysis identified ventricular fibrillation on first electrocardiogram, observed OHCA, short response time intervals but not the unit that performed the first resuscitation attempt as independent predictors of survival.


CONCLUSIONS
A physician on board of the advanced life support unit was not identified as an independent factor of improved survival.
Estner
Heidi L
HL
Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. estner@dhm.mhn.de
Günzel
Christian
C
Ndrepepa
Gjin
G
William
Frederic
F
Blaumeiser
Dirk
D
Rupprecht
Bernd
B
Hessling
Gabriele
G
Deisenhofer
Isabel
I
Weber
Michael A
MA
Wilhelm
Karl
K
Schmitt
Claus
C
Schömig
Albert
A
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000706:statistics & numerical data; D005260:Female; D005843:Geography; D005858:Germany / Q000453:epidemiology; D006323:Heart Arrest / Q000453:epidemiology* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D017678:Sex Distribution; D016019:Survival Analysis; D014838:Volunteers / Q000706:statistics & numerical data; D000078329:Workforce