title: Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest: A Danish nationwide observational study.
abstract: Sudden out-of-hospital cardiac arrest (OHCA) is an important public health problem. While several interventions are known to improve survival, the impact of physician-delivered advanced cardiac life support for OHCA is unclear. We aimed to assess the association between prehospital physician involvement and 30-day survival.
  
  
  
  Observational study including persons registered with first-time OHCA of any cause in the Danish Cardiac Arrest Registry during 2005-2012. We used logistic regression analysis to assess the association between 30-day survival and involvement of a physician at any time before arrival at the hospital. Secondary outcomes were 1-year survival and return of spontaneous circulation (ROSC) before arrival at the hospital. The associations were explored in three multivariable models: a model with simple adjustment, a model with multiple imputation of missing variables, and a propensity score model where exposed subjects were matched 1:1 with unexposed subjects on a propensity score reflecting the probability of being assigned to the exposure group.
  
  
  
  21,165 persons with OHCA during 2005-2012 were included. Overall, 10.8% of OHCA patients with physician involvement and 8.1% of OHCA patients without physician involvement before arrival at hospital were alive after 30 days, crude odds ratio (OR)=1.37 (95% CI=1.24-1.51), adjusted OR=1.18 (95% CI=1.04-1.34). Physician involvement was also positively associated with ROSC, OR=1.09 (95% CI=1.00-1.19); and with 1-year survival, OR=1.13 (95% CI=0.99-1.29).
  
  
  
  In this large population-based observational study, we found prehospital physician involvement after OHCA associated with better 30-day survival. This association was also found for ROSC, but with less certainty for 1-year survival.
authors: Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: annykaw@hotmail.com.
authors: Annika
authors: A
authors: Hamilton
authors: Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark; Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors: Jacob
authors: J
authors: Steinmetz
authors: Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.
authors: Mads
authors: M
authors: Wissenberg
authors: The Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark.
authors: Christian
authors: C
authors: Torp-Pedersen
authors: Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.
authors: Freddy K
authors: FK
authors: Lippert
authors: Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark.
authors: Lars
authors: L
authors: Hove
authors: Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors: Nicolai
authors: N
authors: Lohse
mesh_terms: D022561:Advanced Cardiac Life Support; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012042:Registries; D016019:Survival Analysis
keywords: Emergency medical services; Out-of-hospital cardiac arrest; Prehospital physicians