Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest

A prospective cohort analysis

Akihito Hagihara, Manabu Hasegawa, Takeru Abe, Takashi Nagata, Yoshihiro Nabeshima

    Research output: Contribution to journalArticle

    18 Citations (Scopus)

    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.

    Original languageEnglish
    Article numbere84424
    JournalPLoS One
    Volume9
    Issue number1
    DOIs
    Publication statusPublished - 2014 Jan 8

    Fingerprint

    Ambulance cars
    Out-of-Hospital Cardiac Arrest
    cardiac arrest
    Ambulances
    physicians
    Cohort Studies
    Physicians
    Survival
    cardiopulmonary resuscitation
    Cardiopulmonary Resuscitation
    Resuscitation
    Observational Studies
    Japan
    observational studies
    Logistic Models
    endpoints
    Prospective Studies
    Logistics

    ASJC Scopus subject areas

    • Agricultural and Biological Sciences(all)
    • Biochemistry, Genetics and Molecular Biology(all)
    • Medicine(all)

    Cite this

    Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest : A prospective cohort analysis. / Hagihara, Akihito; Hasegawa, Manabu; Abe, Takeru; Nagata, Takashi; Nabeshima, Yoshihiro.

    In: PLoS One, Vol. 9, No. 1, e84424, 08.01.2014.

    Research output: Contribution to journalArticle

    Hagihara, Akihito ; Hasegawa, Manabu ; Abe, Takeru ; Nagata, Takashi ; Nabeshima, Yoshihiro. / Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest : A prospective cohort analysis. In: PLoS One. 2014 ; Vol. 9, No. 1.
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    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.",
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