Clinical Investigation
Acute Ischemic Heart Disease
Outcome after out-of-hospital cardiac arrest in a physician-staffed emergency medical system according to the Utstein style

https://doi.org/10.1016/j.ahj.2007.02.032Get rights and content

Background

Despite a large amount of data assessing outcomes of out-of-hospital cardiac arrests (OHCAs), little information is available about physician-staffed emergency medical service (EMS) systems. The aim of our study was to investigate the impact of a physician on the outcome of patients after OHCA.

Methods

This is a prospective, observational study that included 539 consecutive patients (63.9 ± 19.1 years old; 349 males) with OHCA in the community of Dachau (135,000 inhabitants) in whom resuscitation was attempted between January 2000 and January 2006 according to Utstein style. Patients were followed up to hospital discharge. The primary end point of the study was that the patients was discharged alive from hospital.

Results

Of 412 patients with an OHCA, 180 (43.7%) were admitted to hospital, and 47 (11.4%) were discharged alive. Resuscitation was started by a physician in 117 (28.4%) patients, by a layperson in 118 (28.6%), or by an EMS personnel in 177 (43.0%). A total of 18 patients (18.6%) treated by physicians, 13 patients (8.0%) treated by EMS personnel (P = .02 vs treatment by physician), and 16 patients (16.5%) resuscitated by laypersons were discharged from hospital (P = .8 vs treatment by physician). In 105 patients with bystander-witnessed OHCA of cardiac origin with shockable rhythm, the discharge rate was 32.4% (n = 34). Multivariate analysis identified ventricular fibrillation on first electrocardiogram, observed OHCA, short response time intervals but not the unit that performed the first resuscitation attempt as independent predictors of survival.

Conclusions

A physician on board of the advanced life support unit was not identified as an independent factor of improved survival.

Section snippets

Patients and methods

This study included all patients who had an OHCA in whom resuscitation was attempted by the Dachau ALS services between January 2000 and January 2006. Pediatric patients were included in the study. The Dachau EMS system serves the city of Dachau, a midsized urban community and its suburban environs covering a population of approximately 134,019 residents in a region of 580 km2. At the time of the study, 48.7% of the residents were male, and 10.6% of residents were ≥70 years of age.

Results

Within a 6-year period, 814 patients that had cardiac arrest were covered by the Dachau ALS services. In 275 of these patients, CPR was not attempted because death was confirmed by postmortem lividity and rigor mortis or because cardiac arrest had obviously occurred after end-stage malignant or other severe chronic disease (Figure 1, A). In 539 patients (349 males, 64.7%; mean age, 63.9 ± 19.1 years; range, 0.1-94.1 years), CPR was initiated. In 149 (27.6%) patients, a defibrillation attempt

Discussion

In a midsized urban/suburban system with 2-tier ALS services, in which the ALS is provided by physicians, 11.4% of patients resuscitated after a cardiac arrest of cardiac etiology were discharged alive. Most of these patients showed good neurological outcome. Several factors influencing outcome could be identified. Factors such as witnessed cardiac arrest, VF in the first recorded ECG, or shorter response time intervals (<8 minutes) were associated with higher survival rates at the time of

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