Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest: A Danish nationwide observational study

TY - JOUR

T1 - Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest

T2 - A Danish nationwide observational study

AU - Hamilton, Annika

AU - Steinmetz, Jacob

AU - Wissenberg, Mads

AU - Torp-Pedersen, Christian

AU - Lippert, Freddy K

AU - Hove, Lars

AU - Lohse, Nicolai

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - AIM: 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.METHODS: 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.RESULTS: 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).CONCLUSION: 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.

AB - AIM: 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.METHODS: 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.RESULTS: 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).CONCLUSION: 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.

KW - Journal Article

U2 - 10.1016/j.resuscitation.2016.08.007

DO - 10.1016/j.resuscitation.2016.08.007

M3 - Journal article

C2 - 27565859

SN - 0300-9572

VL - 108

SP - 95

EP - 101

JO - Resuscitation

JF - Resuscitation

ER -