title: Out-of-hospital cardiac arrest (OHCA) attended by mobile emergency teams with a physician on board. Results of the Spanish OHCA Registry (OSHCAR).
abstract: Most survival outcomes in out-of-hospital cardiac arrest (OHCA) are provided by emergency medical services (EMS) without a doctor on board. Our objective was to determine such outcomes in a whole country with public physician-led EMS.
  
  
  
  We analyzed data from a nationwide prospective registry of OHCA cases attended by 19 public EMS in Spain, covering the period from 1-October 2013 to 30-October 2014.
  
  
  
  Advanced life support (ALS) was initiated in 9347 cases (incidence 18.6 cases/105inhabitants per year). Resuscitation was considered futile in 558 cases (5.9%), and ALS was continued in 8789 cases (94.1%); mean age 63.5±17 years, 72.1% men. Initial rhythm was shockable in 22.1% of cases. Basic life support (BLS) was provided by bystanders in 1602 (24%) cases (635 of them with telephone assistance from the dispatch center). Of 8789 patients receiving ALS, 72.1% men, 2669 (30.4%) patients had return of spontaneous circulation on hospital arrival, 50.6% when the initial rhythm was shockable. Hospital discharge with good neurological status (CPC1-2) was found in 11.1% of the study population and in 27.6% when considering the Utstein comparator group of patients. A total of 216 (2.5%) patients arrived at the hospital with ongoing resuscitation, of whom only one survived with CPC1-2, and 165 (1.9%) patients were included in non-heart-beating donation programs.
  
  
  
  In Spain with physician-led EMS, OHCA survival with CPC1-2reached a reasonable percentage despite only a modest contribution of bystander BLS. Ongoing resuscitation strategy seems to be futile except when considering non-heart beating donation programs.
authors.affiliation: Empresa Pública de Emergencias Sanitarias, Almería, Andalucía, Spain. Electronic address: frosell@al.epes.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rosell-Ortiz
authors.affiliation: Sistema Emergencies Mediques, Catalunya, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Escalada-Roig
authors.affiliation: Hospital Virgen del Rocío, Sevilla, Andalucía, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Fernández Del Valle
authors.affiliation: Fundación Pública Urxencias Sanitarias 061, Galicia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Sánchez-Santos
authors.affiliation: SUMMA112, Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Navalpotro-Pascual
authors.affiliation: Servicio de urgencias extrahospitalarias de Navarra, Navarra, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Echarri-Sucunza
authors.affiliation: SAMU, Emergencias Sanitarias, Comunidad Valenciana, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Adsuar-Quesada
authors.affiliation: SAMU 061 Baleares, Islas Baleares, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Ceniceros-Rozalén
authors.affiliation: Servicio de Urgencias y Emergencias 061, La Rioja, Spain.
authors.forename: José I
authors.initials: JI
authors.lastname: Ruiz-Azpiazu
authors.affiliation: Emergentziak-Emergencias, Osakidetza, Euzkadi, Spain.
authors.forename: Karlos
authors.initials: K
authors.lastname: Ibarguren-Olalde
authors.affiliation: Emergencias Sanitarias, Castilla y León, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: López-Cabeza
authors.affiliation: Servicio de Emergencias 061 Cantabria, Cantabria, Spain.
authors.forename: María V
authors.initials: MV
authors.lastname: Mier-Ruiz
authors.affiliation: Servicio de Urgencias Canario, Islas Canarias, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Martín-Sánchez
authors.affiliation: SAMU-Asturias, Asturias, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Martínez Del Valle
authors.affiliation: 061 e Instituto de Ciencias de la Salud, Aragón, Spain.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Inza-Muñoz
authors.affiliation: Emergencias sanitarias de Extremadura, Extremadura, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Cordero Torres
authors.affiliation: SAMUR Protección Civil, Madrid, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: García-Ochoa
authors.affiliation: Servicio de Bomberos de Zaragoza, Aragón, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Cortés-Ramas
authors.affiliation: Servicio de Urgencias y Emergencias, Castilla La Mancha, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Canabal-Berlanga
authors.affiliation: Servicio de Emergencias 061, Murcia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Zoyo López-Navarro
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Río Carrión, Palencia, Spain.
authors.forename: Juan B
authors.initials: JB
authors.lastname: López-Messa
authors.affiliation: Empresa Pública de Emergencias Sanitarias, Andalucía, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: García Del Águila
authors.affiliation: Emergentziak-Emergencias, Osakidetza, Euzkadi, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Alonso-Moreno
authors.affiliation: Emergencias Sanitarias, Castilla y León, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Pozo-Pérez
authors.affiliation: Emergencias sanitarias de Extremadura, Extremadura, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Bravo-Castello
authors.affiliation: Servicio de Urgencias y Emergencias, Castilla La Mancha, Spain.
authors.forename: Natividad
authors.initials: N
authors.lastname: Ramos-García
authors.affiliation: Servicio de Emergencias 061, Murcia, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Gómez-Larrosa
authors.affiliation: Hospital el Toyo, Almería, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Mellado-Vergel
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D004632:Emergency Medical Services / Q000379:methods / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010819:Physician's Role; D012042:Registries / Q000706:statistics & numerical data; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis
keywords: Emergency medical services; Out-of-hospital cardiac arrest; Physician on board; Survival