Abstract
Background
The decision to initiate or continue advanced life support (ALS) in out-of-hospital
cardiac arrest (OHCA) could be difficult due to the lack of information and contextual
elements, especially in non-shockable rhythms. This study aims to explore factors
associated with clinicians’ decision to initiate or continue ALS and the conditions
associated with higher variability in asystolic patients.
Methods
This retrospective observational study enrolled 2653 asystolic patients on whom either
ALS was attempted or not by the emergency medical services (EMS) physician. A multivariable
logistic regression analysis was performed to find the factors associated with the
decision to access ALS. A subgroup analysis was performed on patients with a predicted
probability of ALS between 35% and 65%. The single physician’s behaviour was compared
to that predicted by the model taking into account the entire agency.
Results
Age, location of event, bystander cardiopulmonary resuscitation and EMS-witnessed
event were independent factors influencing physicians’ choices about ALS. Non-medical
OHCA, younger patients, less experienced physicians, presence of breath activity at
the emergency call and a longer time for ALS arrival were more frequent among cases
with an expected higher variability in behaviours with ALS. Significant variability
was detected between physicians.
Conclusions
Significant inter-physician variability in access to ALS could be present within the
same EMS, especially among less experienced physicians, non-medical OHCA and in presence
of signs of life during emergency call. This arbitrariness has been observed and should
be properly addressed by EMS team members as it raises ethical issues regarding the
disparity in treatment.
Keywords
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Article info
Publication history
Published online: June 24, 2022
Accepted:
June 19,
2022
Received in revised form:
June 17,
2022
Received:
April 27,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
