Out-of hospital advanced life support with or without a physician: effects on quality of CPR and outcome.
BACKGROUND
The presence of physicians is believed to facilitate optimal management of out-of-hospital cardiac arrest, but has not been sufficiently documented.


METHODS
Adult non-traumatic cardiac arrests treated by Oslo EMS between May 2003 and April 2008 were prospectively registered. Patients were categorized according to being treated by the physician-manned ambulance (PMA) or by regular paramedic-manned ambulances (non-PMA). Patient records and continuous electrocardiograms (ECGs) with impedance signals were reviewed. Quality of cardiopulmonary resuscitation (CPR) and clinical outcomes were compared.


RESULTS
Resuscitation was attempted in 1128 cardiac arrests, of which 151 treated by non-PMA and PMA together were excluded from comparative analysis. Of the remaining 977 patients, 232 (24%) and 741 (76%) were treated by PMA and non-PMA, respectively. The PMA group was more likely to have bystander witnessed arrests and initial VF/VT, and received better CPR quality with shorter hands-off intervals and pre-shock pauses, and having a greater proportion of patients being intubated. Despite uneven distribution of positive prognostic factors and better CPR quality, short-term and long-term survival were not different for patients treated by the PMA vs. non-PMA, with 34% vs. 33% (p=0.74) achieving return of spontaneous circulation (ROSC), 28% vs. 25% (p=0.50) being admitted to ICU and 13% vs. 11% (p=0.28) being discharged from hospital, respectively.


CONCLUSIONS
Survival after out-of-hospital cardiac arrest was not different for patients treated by the PMA and non-PMA in our EMS system.
Olasveengen
Theresa M
TM
Institute for Experimental Medical Research, Department of Anesthesiology, Oslo University Hospital, Ullevaal, Oslo, Norway. t.m.olasveengen@medisin.uio.no
Lund-Kordahl
Inger
I
Steen
Petter A
PA
Sunde
Kjetil
K
D022561:Advanced Cardiac Life Support / Q000592:standards*; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000592:standards; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D015996:Survival Rate