Abstract 108: A Physician Onboard the Advanced Life Support Unit Has a Clinical Impact on Outcome of Witnessed Patients With Out-of-Hospital Cardiac Arrest
Background: Despite a large amount of data focusing on outcome of out-of-hospital cardiac arrest (OHCA), little information is available with regard to the significance of a physician on board the advanced life support (ALS) unit. We assessed the hypothesis that a physician on board the ALS unit has an impact on the improved survival of patients with OHCA through prehospital ALS measures.
Methods and Results: From January 1, 2005, through December 31, 2008, we conducted a prospective, population-based, observational study involving consecutive patients across Japan who had an OHCA and in whom resuscitation was attempted by emergency responders. The primary outcome measure was the 1-month rate of survival with minimal neurologic impairment. A total of 431,968 who had an OHCA were included in the study; 96,515 of these patients had an arrest that was of cardiac origin and that was witnessed by bystanders. Survival at 1-month with minimal neurological impairment was significantly higher in patients under the presence of a physician on board the ALS unit compared with only emergency providers including Emergency Life-Saving Technicians (ELSTs) who have undergone extensive training in the provision of prehospital emergency care. Even after the technique of propensity score matching for clinical characteristics was used to minimize the effect of selection bias on outcome, the patients under a physician on board the ALS unit showed significantly higher survival with the differences of prehospital ALS measures (Table). Prehospital ALS measures were major influence as an effect modifying factor on a physician onboard the ALS unit (P=0.002).
Conclusions: A physician onboard the ALS unit has incremental benefit to patients with OHCA. Our findings may help missing link between clinical improvement in OHCA patients and physician-initiative treatments in addition to prehospital ALS measures although the quality of ALS measures might be a contributing factor for patients outcome.
- © 2010 by American Heart Association, Inc.