Advertisement

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

  • Annika Hamilton
    Correspondence
    Corresponding author at: Department of Anaesthesiology and Intensive Care 532, Hvidovre Hospital, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark.
    Affiliations
    Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
    Search for articles by this author
  • Jacob Steinmetz
    Affiliations
    Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark

    Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
    Search for articles by this author
  • Mads Wissenberg
    Affiliations
    Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
    Search for articles by this author
  • Christian Torp-Pedersen
    Affiliations
    The Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark
    Search for articles by this author
  • Freddy K. Lippert
    Affiliations
    Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
    Search for articles by this author
  • Lars Hove
    Affiliations
    Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark

    Emergency Medical Services Copenhagen, Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
    Search for articles by this author
  • Nicolai Lohse
    Affiliations
    Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark

    Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
    Search for articles by this author

      Abstract

      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.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Höglund H.
        • Jansson J.-H.
        • Forslund A.-S.
        • Lundblad D.
        Prodromal symptoms and health care consumption prior to out-of-hospital cardiac arrest in patients without previously known ischaemic heart disease.
        Resuscitation. 2014; 85 (Available from: http://www.sciencedirect.com/science/article/pii/S0300957214004444 [cited 14.05.15]): 864-868
        • Wissenberg M.
        • Lippert F.K.
        • Folke F.
        • et al.
        Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest.
        JAMA. 2013; 310 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/24084923 [cited 20.03.15]): 1377-1384
      1. Hansen SM, Wissenberg M, Rajan S, Hansen CM, Mortensen RN, Folke F, et al. Hjertestop udenfor hospital i Danmark, Sammenfatning af resultater fra Dansk Hjertestopregister 2001–2012; 2012.

        • Sasson C.
        • Rogers M.A.M.
        • Dahl J.
        • Kellermann A.L.
        Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis.
        Circ Cardiovasc Qual Outcomes. 2010; 3 (Available from: http://circoutcomes.ahajournals.org/content/3/1/63.abstract [cited 24.02.15]): 63-81
        • Søholm H.
        • Hassager C.
        • Lippert F.
        • et al.
        Factors associated with successful resuscitation after out-of-hospital cardiac arrest and temporal trends in survival and comorbidity.
        Ann Emerg Med. 2014; (Available from: http://www.sciencedirect.com/science/article/pii/S0196064414015777 [cited 30.03.15])
        • Hess E.P.
        • White R.D.
        Optimizing survival from out-of-hospital cardiac arrest.
        J Cardiovasc Electrophysiol. 2010; 21 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/20132388 [cited 26.03.15]): 590-595
        • Christenson J.
        • Andrusiek D.
        • Everson-Stewart S.
        • et al.
        Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation.
        Circulation. 2009; 120 (Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2795631&tool=pmcentrez&rendertype=abstract [cited 10.05.15]): 1241-1247
        • Bossaert L.L.
        The complexity of comparing different EMS systems—a survey of EMS systems in Europe.
        Ann Emerg Med. 1993; 22 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/8424624 [cited 14.05.15]): 99-102
        • Soo L.H.
        • Gray D.
        • Young T.
        • Huff N.
        • Skene A.
        • Hampton J.R.
        Resuscitation from out-of-hospital cardiac arrest: is survival dependent on who is available at the scene?.
        Heart. 1999; 81 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/10220544 [cited 20.03.15]): 47-52
        • Olasveengen T.M.
        • Lund-Kordahl I.
        • Steen P.A.
        • Sunde K.
        Out-of hospital advanced life support with or without a physician: effects on quality of CPR and outcome.
        Resuscitation. 2009; 80 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/19709795 [cited 20.03.15]): 1248-1252
        • Yen Z.-S.
        • Chen Y.-T.
        • Ko P.C.-I.
        • et al.
        Cost-effectiveness of different advanced life support providers for victims of out-of-hospital cardiac arrests.
        J Formos Med Assoc. 2006; 105 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/17185242 [cited 20.03.15]): 1001-1007
        • Böttiger B.W.
        • Grabner C.
        • Bauer H.
        • et al.
        Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area.
        Heart. 1999; 82 (Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1729199&tool=pmcentrez&rendertype=abstract [cited 20.03.15]): 674-679
        • Estner H.L.
        • Günzel C.
        • Ndrepepa G.
        • et al.
        Outcome after out-of-hospital cardiac arrest in a physician-staffed emergency medical system according to the Utstein style.
        Am Heart J. 2007; 153 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/17452155 [cited 20.03.15]): 792-799
        • Dyson K.
        • Bray J.
        • Smith K.
        • Bernard S.
        • Finn J.
        A systematic review of the effect of emergency medical service practitioners’ experience and exposure to out-of-hospital cardiac arrest on patient survival and procedural performance.
        Resuscitation. 2014; 85 (Available from: http://www.sciencedirect.com/science/article/pii/S0300957214005619 [cited 17.03.15]): 1134-1141
      2. Statistics Denmark Summary vital statistics. Statistics Denmark website.
        2015 (http://www.statistikbanken.dk/HISB3 [accessed 21.04.15])
      3. Statistics Denmark Summary vital statistics. Statistics Denmark website.
        2015 (http://www.statistikbanken.dk/ARE207 [accessed 21.04.15])
        • Kindberg K.
        • Nielsen S.L.
        • Møller A.M.
        Physician-based prehospital units in Denmark.
        Ugeskr Laeger. 2009; 171 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/19732545 [cited 20.03.15]): 2553-2557
        • Perkins G.D.
        • Jacobs I.G.
        • Nadkarni V.M.
        • et al.
        Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest.
        Resuscitation. 2014; (Available from: http://www.sciencedirect.com/science/article/pii/S0300957214008119 [cited 18.03.15])
        • Wissenberg M.
        • Hansen C.M.
        • Folke F.
        • et al.
        Survival after out-of-hospital cardiac arrest in relation to sex: a nationwide registry-based study.
        Resuscitation. 2014; 85 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/24960430 [cited 20.03.15]): 1212-1218
        • Pedersen C.B.
        The Danish Civil Registration System.
        Scand J Public Health. 2011; 39 (Available from: http://sjp.sagepub.com/content/39/7_suppl/22.short?rss=1&ssource=mfc [cited 13.02.15]): 22-25
        • Pedersen C.B.
        • Gøtzsche H.
        • Møller J.O.
        • Mortensen P.B.
        The Danish Civil Registration System. A cohort of eight million persons.
        Dan Med Bull. 2006; 53 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/17150149 [cited 25.02.15]): 441-449
        • Lynge E.
        • Sandegaard J.L.
        • Rebolj M.
        The Danish National Patient Register.
        Scand J Public Health. 2011; 39: 30-33
        • Andersen T.F.
        • Madsen M.
        • Jørgensen J.
        • Mellemkjoer L.
        • Olsen J.H.
        The Danish National Hospital Register. A valuable source of data for modern health sciences.
        Dan Med Bull. 1999; 46 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/10421985 [cited 05.02.15]): 263-268
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/3558716 [cited 10.07.14]): 373-383
        • Thygesen S.K.
        • Christiansen C.F.
        • Christensen S.
        • Lash T.L.
        • Sørensen H.T.
        The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of Patients.
        BMC Med Res Methodol. 2011; 11 (Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3125388&tool=pmcentrez&rendertype=abstract [cited 09.12.14]): 83
        • Steinmetz J.
        • Barnung S.
        • Nielsen S.L.
        • Risom M.
        • Rasmussen L.S.
        Improved survival after an out-of-hospital cardiac arrest using new guidelines.
        Acta Anaesthesiol Scand. 2008; 52 (Available from: http://www.ncbi.nlm.nih.gov/pubmed/18477076 [cited 13.05.15]): 908-913