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Abstract
Objective This study aimed to assess the benefits of adding a physician-staffed ambulance to bystander-witnessed out-of-hospital cardiac arrest using a community-based registry.
Design Population-based, retrospective cohort study.
Setting An urban city with approximately 800 000 residents.
Participants Patients aged ≥18 years with bystander-witnessed out-of-hospital cardiac arrests of medical aetiology in Niigata City, Japan, between January 2012 and December 2016, according to the Utstein style.
Primary and secondary outcome measures The primary outcome was 1-month survival with a favourable neurological outcome, defined as a cerebral performance category score of 1 or 2. We used logistic regression analysis to assess the association between favourable neurological outcome and prehospital physician involvement.
Results During the study period, a total of 4172 cardiac arrests were registered; of these, 892 patients with out-of-hospital cardiac arrest were eligible for this analysis, among whom 135 (15.1%) had prehospital physician involvement and 757 (84.9%) did not have prehospital physician involvement. The percentage of favourable neurological outcomes was 20.7% (28 of 135) in those with physician involvement and 10.4% (79 of 757) in those without physician involvement (p=0.001). Using multivariable logistic regression, prehospital physician involvement had an OR for a favourable neurological outcome of 3.44 (95% CI 1.64 to 7.23).
Conclusions Among adults with out-of-hospital cardiac arrest, adding a physician-staffed ambulance was associated with significantly greater favourable neurological outcomes than standard emergency medical services.
- advanced cardiac life support
- cardiopulmonary resuscitation
- emergency medical services
- out-of-hospital cardiac arrest
- physician
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Footnotes
Contributors NS conceived the study. TM, KA, KN and YH supervised the conduct of the trial and data collection. NS managed the data, including quality control. TM and KA provided statistical advice on the study design and analysed the data. NS chaired the data oversight committee. NS, TM and YH drafted the manuscript, and all authors contributed substantially to its revision. NS takes responsibility for the paper as a whole. All authors read and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was approved by the Institutional Ethics Review Board of Niigata City General Hospital (17-060), and the requirement for patient informed consent was waived.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.