title: Analysis of out-of-hospital cardiac arrest in Croatia - survival, bystander cardiopulmonary resuscitation, and impact of physician's experience on cardiac arrest management: a single center observational study.
abstract: OBJECTIVE
  To analyze the initial rhythm, bystander cardiopulmonary resuscitation (CPR) rate, and survival after out-of-hospital cardiac arrests (OHCA) in Varaľdin County (Croatia), and to investigate whether physician's inexperience in emergency medical services (EMS) has an impact on resuscitation management.
  
  
  METHODS
  We reviewed clinical records and Revised Utstein cardiac arrest forms of all out-of-hospital resuscitations performed by EMS Varaľdin (EMSVz), Croatia, from 2007-2013. To analyze the impact of physician's inexperience in EMS (<1 year in EMS) on resuscitation management, we assessed physician's turnover in EMSVz, as well as OHCA survival, airway management, and adherence to resuscitation guidelines in regard to physician's EMS experience.
  
  
  RESULTS
  Of 276 patients (median age 68 years, interquartile range [IQR] 16; 198 male; 37% ventricular fibrillation/ventricular tachycardia, bystander CPR rate 25%), 80 were transferred to hospital and 39 were discharged (median survival after discharge 23 months, IQR 46 months). During the 7-year study period, 29 newly graduated physicians inexperienced in EMS started to work in EMSVz (performing 77 resuscitations), while 48% of them stayed for less than one year. Airway management depended on physician's EMS experience (P=0.018): inexperienced physicians performed bag-valve-mask ventilation (BMV) more than the experienced, with no impact on survival rate. Physician's EMS experience did not influence adherence to resuscitation guidelines (P=0.668), survival to hospital discharge (P=0.791), or survival time (P=0.405).
  
  
  CONCLUSIONS
  OHCA survival rate of EMSVz resuscitations was higher than in Europe, but bystander CPR needs to be improved. Compared to experienced physicians, inexperienced physicians preferred BMV over intubation, but with similar adherence to resuscitation guidelines and survival after OHCA.
authors.affiliation: Anita Lukic, V. Sokola 19, Varazdin, HR42000, Croatia, lukic.anita@yahoo.com.
authors.forename: Anita
authors.initials: A
authors.lastname: Lukić
authors.forename: Ileana
authors.initials: I
authors.lastname: Lulić
authors.forename: Dinka
authors.initials: D
authors.lastname: Lulić
authors.forename: Zoran
authors.initials: Z
authors.lastname: Ognjanović
authors.forename: Davorin
authors.initials: D
authors.lastname: Cerovečki
authors.forename: Siniša
authors.initials: S
authors.lastname: Telebar
authors.forename: Ivica
authors.initials: I
authors.lastname: Mašić
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002983:Clinical Competence; D017523:Croatia; D004632:Emergency Medical Services / Q000379:methods*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D010820:Physicians; D016019:Survival Analysis; D015996:Survival Rate