General practitioner contribution to out-of-hospital cardiac arrest outcome: A national registry study.
BACKGROUND
There is a wide variation in reported survival from out-of-hospital cardiac arrest (OHCA). One factor in this variation may be the contribution of general practitioners to pre-hospital resuscitation. Studies using self-reported data describe increased survival proportions when general practitioners are involved.


OBJECTIVE
This study aims to investigate the contribution of general practitioner involvement in out-of-hospital cardiac arrest events.


METHODS
A retrospective observational study using data collected from ambulance records in the Republic of Ireland to describe general practitioner (GP) contribution to pre-hospital resuscitation attempts (n = 2369). Analysis is limited to patients with presumed cardiac cause and first arrest rhythm recorded as shockable (n = 510).


RESULTS
When a GP is present at scene (n = 199) patients are less likely to achieve return of spontaneous circulation (ROSC) (P < 0.001) or be transported to hospital (P < 0.001). When GPs participate in resuscitation (n = 92), patients are more likely to have collapsed in a public place (P < 0.01), receive bystander CPR (P < 0.001) and survive to hospital discharge (P < 0.001). Multiple logistic analysis of survival suggests that GP participation in resuscitation increases the odds of survival (4.6; 95% CI 1.6-13.3) and having collapsed in a public place increases chances of survival (5.8; 95% CI 2.1-15.7).


CONCLUSIONS
Our analysis suggests that in this subgroup, GP participation in OHCA resuscitation attempts is associated with improved patient survival. Furthermore, resuscitation is more likely to be ceased at scene when a GP is present, highlighting the role that GPs play in the compassionate management of death in unviable circumstances.
Department of Public Health Medicine, St Conal's Hospital HSE NW , Letterkenny, Co. Donegal , Ireland.
Siobhán
S
Masterson
Akke
A
Vellinga
Peter
P
Wright
John
J
Dowling
Gerard
G
Bury
Andrew W
AW
Murphy
D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D005392:First Aid; D058006:General Practice; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D012042:Registries; D012151:Resuscitation; D012189:Retrospective Studies; D015996:Survival Rate
Out-of-hospital cardiac arrest; cardiopulmonary resuscitation; general practitioners