title: The contributions of emergency physicians to out-of-hospital cardiopulmonary arrest: an analysis of the national Utstein Registry data.
abstract: BACKGROUND
  Emergency physicians are likely to play an important role in the "chain of survival." The relationship between the number of emergency physicians and out-of-hospital cardiopulmonary arrest (OHCA) prognosis is not well understood.
  
  
  OBJECTIVE
  We assessed the impact of the number of emergency physicians on the outcomes of OHCA.
  
  
  METHODS
  In a nationwide, population-based, observational study, we enrolled 120,721 adults aged ≥ 18 years with OHCA, from January 1, 2010 to December 31, 2010. We used the countrywide Utstein Registry database coupled with health statistics data surveyed by the Ministry of Health, Labour and Welfare. The primary endpoint was favorable neurological outcomes 1 month after OHCA.
  
  
  RESULTS
  During the study period, OHCA occurred in 25,580 people (21.2%) in an area with the number of emergency physicians/100,000 population < 1.5, in 62,299 people (51.6%) in an area with ≥ 1.5 and < 3.0 emergency physicians/100,000 population, in 30,948 people (25.6%) in an area with ≥ 3.0 and < 4.5 emergency physicians/100,000 population, and in 1894 people (1.6%) in an area with ≥ 4.5 emergency physicians/100,000 population. Patient prognosis became more favorable as the number of emergency physicians increased (1-month survival: 5.08% vs. 5.81% vs. 5.90% vs. 8.82%, p < 0.0001; and favorable neurological outcomes: 2.64% vs. 2.84% vs. 3.23% vs. 3.54%, p < 0.0001; for emergency physicians/100,000 population of < 1.5, ≥ 1.5 and < 3.0, ≥ 3.0 and < 4.5, and ≥ 4.5, respectively). The adjusted odds ratio for favorable neurological outcomes per increase of one emergency physician/100,000 population was 1.06 (95% confidence interval 1.01-1.11, p = 0.0163).
  
  
  CONCLUSIONS
  An increased number of emergency physicians/100,000 population is likely to be associated with improved outcomes.
authors.affiliation: Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Tatsuma
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Ohashi
authors.affiliation: Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Matsubara
authors.affiliation: Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yahagi
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010819:Physician's Role; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D000078329:Workforce; D055815:Young Adult
keywords: cardiopulmonary resuscitation; database; emergency services; health policy; out-of-hospital cardiac arrest