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PLoS One. 2014 Jan 8;9(1):e84424. doi: 10.1371/journal.pone.0084424. eCollection 2014.

Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest: a prospective cohort analysis.

Author information

1
Department of Health Services Management and Policy, Kyushu University Graduate School of Medicine, Fukuoka, Japan.
2
Ambulance Service Planning Division, Fire and Disaster Management Agency, Ministry of Internal Affairs and Communications, Tokyo, Japan.
3
Faculty of Human Sciences, Waseda University, Tokorozawa, Japan.
4
Department of Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.

Abstract

The presence of a physician seems to be beneficial for pre-hospital cardiopulmonary resuscitation (CPR) of patients with out-of-hospital cardiac arrest. However, the effectiveness of a physician's presence during CPR before hospital arrival has not been established. We conducted a prospective, non-randomized, observational study using national data from out-of-hospital cardiac arrests between 2005 and 2010 in Japan. We performed a propensity analysis and examined the association between a physician's presence during an ambulance car ride and short- and long-term survival from out-of-hospital cardiac arrest. Specifically, a full non-parsimonious logistic regression model was fitted with the physician presence in the ambulance as the dependent variable; the independent variables included all study variables except for endpoint variables plus dummy variables for the 47 prefectures in Japan (i.e., 46 variables). In total, 619,928 out-of-hospital cardiac arrest cases that met the inclusion criteria were analyzed. Among propensity-matched patients, a positive association was observed between a physician's presence during an ambulance car ride and return of spontaneous circulation (ROSC) before hospital arrival, 1-month survival, and 1-month survival with minimal neurological or physical impairment (ROSC: OR = 1.84, 95% CI 1.63-2.07, p = 0.00 in adjusted for propensity and all covariates); 1-month survival: OR = 1.29, 95% CI 1.04-1.61, p = 0.02 in adjusted for propensity and all covariates); cerebral performance category (1 or 2): OR = 1.54, 95% CI 1.03-2.29, p = 0.04 in adjusted for propensity and all covariates); and overall performance category (1 or 2): OR = 1.50, 95% CI 1.01-2.24, p = 0.05 in adjusted for propensity and all covariates). A prospective observational study using national data from out-of-hospital cardiac arrests shows that a physician's presence during an ambulance car ride was independently associated with increased short- and long-term survival.

PMID:
24416232
PMCID:
PMC3885569
DOI:
10.1371/journal.pone.0084424
[Indexed for MEDLINE]
Free PMC Article

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