Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Sample, and Setting
2.2. Description of Prehospital Emergency Medical Services in the Region
2.3. Study Population
2.4. Inclusion Criteria
2.5. Study Variables
2.6. Data Analysis
3. Results
3.1. Baseline Characteristics
3.2. Initial Shockable Rhythms
3.2.1. Global Survival Rates
3.2.2. CPC 1-2 Survival Rates
3.3. Initial Non-Shockable Rhythms
3.3.1. Global Survival Rates
3.3.2. CPC 1-2 Survival Rates
3.4. Explanatory Logistic Regression Model
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Global | Emergency Dedicated Physicians | Non-Emergency Dedicated Physicians | BLS Emergency Medical Technicians | p-Value |
---|---|---|---|---|---|
Study population (n, %) | 1359 (100) | 505 (37.2) | 458 (33.7) | 395 (29.1) | 0.001 |
Sex, (n, %) | |||||
Male | 875 (64.4) | 361 (41.3) | 275 (31.4) | 239 (27.3) | >0.005 |
Female | 483 (35.6) | 144 (29.8) | 183 (37.9) | 156 (32.3) | >0.005 |
Age, median (IQR) | 70.03 (22–95) | 66.82 (22–95) | 72.86 (29–95) | 70.85 (26–94) | <0.001 |
<65 years old (n,%) | 421 (31.0) | 201 (47.7) | 109 (25.9) | 111 (26.4) | <0.001 |
From 66 to 75 years old (n,%) | 367 (27.0) | 144 (39.2) | 115 (31.3) | 108 (29.4) | < 0.001 |
>76 years old (n,%) | 570 (42.0) | 160 (28.1) | 234 (41.1) | 176 (30.9) | < 0.001 |
First rhythm Shockable (n, %) | 281 (20.7) | 156 (30.9) | 50 (10.9) | 75 (19.0) | >0.005 |
Non-shockable (n, %) | |||||
Asystole | 402 (29.6) | 128 (25.3) | 146 (31.9) | 128 (32.4) | >0.005 |
Undefined | 64 (4.7) | 0 (0.0) | 39 (8.5) | 25 (6.3) | >0.005 |
PEA | 611 (45.0) | 221 (43.8) | 223 (48.7) | 167 (42.3) | >0.005 |
EMS (n) | ROSC (n, %) | Hospital (n, %) | 30 Days (n, %) | 1 Year (n, %) | 5 Years (n, %) | |
---|---|---|---|---|---|---|
Total | (1) EMTs (n = 395) | 63 (15.9) | 67 (17.0) | 37 (9.4) | 28 (7.1) | 23 (5.8) |
(2) N-EDPhy (n = 458) | 56 (12.2) | 48 (10.5) | 21 (4.6) | 16 (3.5) | 12 (2.6) | |
(3) EDPhy (n = 505) | 287 (56.8) | 265 (52.5) | 175 (34.7) | 153 (30.3) | 126 (25.0) | |
Global | n = 1358 | 406 (29.9) | 380 (28.0) | 233 (17.2) | 197 (14.5) | 161 (11.9) |
Odds Ratio (CI) | ||||||
2 vs. 1 | 0.77 (0.54–1.07) | 0.62 (0.44–0.87) ** | 0.49 (0.29–0.82) ** | 0.49 (0.27–0.89) *** | 0.45 (0.23–0.89) *** | |
3 vs. 1 | 8.75 (6.28–12.19) * | 5.40 (3.94–7.41) * | 5.15 (3.50–7.56) * | 5.68 (3.70–8.72) * | 5.38 (3.37–8.57) * | |
3 vs. 2 | 12.45 (8.87–17.48) * | 9.43 (6.67–13.33) * | 11.06 (6.88–17.79) * | 12.01-(7.04–20.47) * | 12.36 (6.73–22.69) * | |
Shockable Initial rhythm | (1) EMTs (n = 75) | 31 (41.3) | 33 (44.0) | 27 (36.0) | 24 (32.0) | 22 (29.3) |
(2) N-EDPhy (n = 50) | 14 (28.0) | 12 (24.0) | 9 (18.0) | 8 (16.0) | 7 (14.0) | |
(3)EDPhy (n = 156) | 127 (81.4) | 123 (78.8) | 111 (71.6) | 104 (66.7) | 92 (59.0) | |
Global | n = 281 | 172 (61.2) | 168 (59.8) | 147 (52.5) | 136 (48.4) | 121 (43.1) |
Odds Ratio (CI) | ||||||
2 vs. 1 | 0.67 (0.40–1,14) *** | 0.54 (0.31–0.95) *** | 0.50 (0.26–0.97) *** | 0.50(0.24–1.02) *** | 0.47 (0.22–1.03) *** | |
3 vs. 1 | 6.947 (3.63–13.28) * | 4.744 (2.61–8.61) * | 4.485 (2.49–8.06) * | 4.250 (2.36–7.65) * | 3.46 (1.918–6.25) * | |
3 vs. 2 | 14.199 (6.64–30.38) * | 11.80 (5.52–25.09) * | 11.49 (5.16–25.61) * | 10.50 (4.60–23.99) * | 8.83 (3.74–20.87) * | |
Non-shockable Initial rhythm | (1) EMTs (n = 320) | 32 (10.0) | 34 (10.6) | 10 (3.1) | 4 (1.3) | 1 (0.3) |
(2) N-EDPhy (n = 408) | 42 (10.3) | 36 (8.82) | 12 (2.94) | 8 (1.96) | 5 (1.22) | |
(3) EDPhy (n = 349) | 160 (45.8) | 142 (40.7) | 64 (18.3) | 49 (14.0) | 34 (9.7) | |
Global | n = 1077 | 234 (21.7) | 212 (19.7) | 86 (8.0) | 61 (5.7) | 40 (3.7) |
Odds Ratio (CI) | ||||||
2 vs. 1 | 1.000 (0.62–1.63) | 0.83 (0.53–1.29) | 0.94 (0.41–2.15) | 1.56 (0.47–5.14) | 3.92 (0.46–33.39) | |
3 vs. 1 | 9.789 (6.36–15.05) * | 5.770 (3.81–8.74) * | 6.961 (3.50–13.82) * | 12.863 (4.59–36.08) * | 34.432 (4.68–253.06) * | |
3 vs. 2 | 9.792 (6.62–14.48) * | 7.089 (4.74–10.61) * | 7.411 (3.93–13.98 ) * | 8.167(3.81–17.50) * | 8.700 (3.64–22.50) * |
EDPhy (1) (n, %) | N-EDPhy (2) (n, %) | EMTs (3) (n, %) | p-Value | Odds Ratio (CI) | |||
---|---|---|---|---|---|---|---|
Global | Total resuscitations | 505 (37.2) | 458 (33.7) | 395 (29.1) | 0.001 | - | |
Overall survival at 30 days with CPC | 160 (31.68) | 18 (3.93) | 29 (7.34) | <0.001 | 1 vs. 2 | 5.54 (3.56–8.62) | |
1 vs. 3 | 3.35 (2.38–4.72) | ||||||
2 vs. 3 | 0.736 (0.580–0.93) | ||||||
Overall survival at 1 year with CPC | 142 (27.97) | 14 (3.06) | 25 (6.32) | <0.001 | 1 vs. 2 | 6.13 (3.70–10.14) | |
1 vs. 3 | 3.37 (2.33–4.87) | ||||||
2 vs. 3 | 0.70 (0.55–0.90) | ||||||
Overall survival at 5 years with CPC | 120 (24.95) | 12 (2.62) | 21 (5.82) | <0.001 | 1 vs. 2 | 5.90 (3.43–10.16) | |
1 vs. 3 | 3.38 (2.21–4.94) | ||||||
2 vs. 3 | 0.71 (0.54–0.93) | ||||||
Shockable Initial rhythm | Total resuscitations | 156 (55.51) | 50 (17.79) | 75 (26.69) | <0.001 | - | |
Overall survival at 30 days with CPC | 108 (69.23) | 8 (16.0) | 24 (32.0) | <0.001 | 1 vs. 2 | 6.76 (3.34–13.68) | |
1 vs. 3 | 2.83 (1.88–4.26) | ||||||
2 vs. 3 | 0.73 (0.55–0.96) | ||||||
Overall survival at 1 year with CPC | 99 (63.46) | 8 (16.0) | 22 (29.73) | <0.001 | 1 vs. 2 | 5.67 (2.80–11.48) | |
1 vs. 3 | 2.65 (0.1.73–4.05) | ||||||
2 vs. 3 | 0.76 (0.57–1.00) | ||||||
Overall survival at 5 years with CPC | 91 (58.33) | 8 (16.0) | 20 (26.66) | <0.001 | 1 vs. 2 | 4.85 (2.40–9.83) | |
1 vs. 3 | 2.54 (1.63–3.95) | ||||||
2 vs. 3 | 0.79 (0.59–1.06) | ||||||
Total resuscitations | 349 (32.40) | 408 (37.88) | 320 (29.71) | 0.004 | - | ||
Non-shockable Initial rhythm | Overall survival at 30 days with CPC | 52 (14.89) | 10 (2.45) | 5 (1.56) | <0.001 | 1 vs. 2 | 3.55 (2.00–6.28) |
1 vs. 3 | 5.86 (2.53–13.60) | ||||||
2 vs. 3 | 1.32 (0.64–2.72) | ||||||
Overall survival at 1 year with CPC | 43 (12.32) | 6 (1.47) | 3 (0.94) | <0.001 | 1 vs. 2 | 4.63 (2.18–9.83) | |
1 vs. 3 | 7.80 (2.60–23.36) | ||||||
2 vs. 3 | 1.32 (0.52–3.34) | ||||||
Overall survival at 5 years with CPC | 29 (8.30) | 4 (0.98) | 1 (0.31) | <0.001 | 1 vs. 2 | 4.60 (1.83–11.56) | |
1 vs. 3 | 14.97 (2.17–103.03) | ||||||
2 vs. 3 | 2.20 (0.38–12.75) |
95% CI | ||||||
---|---|---|---|---|---|---|
Chi2 Wald | p-Value | Exp (B) | Low | Up | ||
Survival | Model 1 | |||||
ROSC | 197.61 | <0.001 | 11.35 | 7.93 | 16.26 | |
Hospital | 176.09 | <0.001 | 9.487 | 6.62 | 13.58 | |
30 days | EDPhy | 97.61 | <0.001 | 12.07 | 7.01 | 18.36 |
1 year | 81.41 | <0.001 | 14.37 | 7.03 | 20.75 | |
5 years | 60.72 | <0.001 | 11.66 | 6.29 | 21.62 | |
Model 2 | ||||||
ROSC | EMTs | 2.868 | 0.090 | 1.402 | 0.948 | 2.072 |
<65 years old | 7.086 | 0.008 | 1.572 | 1.127 | 2.193 | |
Hospital | EMTs | 7.024 | 0.008 | 1.716 | 1.151 | 2.558 |
<65 years old | 6.07 | 0.014 | 1.530 | 1.09 | 2.15 | |
30 days | EMTs | 4.95 | 0,026 | 1.91 | 1.08 | 3.37 |
<65 years old | 17.21 | <0.001 | 2.30 | 1.55 | 3.41 | |
1 year | EMTs | 3.66 | 0.041 | 1.88 | 0.98 | 3.59 |
<65 years old | 18.30 | <0.001 | 2.206 | 1.427 | 3.411 | |
5 years | EMTs | 3.580 | 0.058 | 2.061 | 0.974 | 4.358 |
<65 years old | 26.707 | <0.001 | 3.800 | 2.290 | 6.305 |
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Freire-Tellado, M.; Navarro-Patón, R.; Mateos-Lorenzo, J.; Pérez-López, G.; Pavón-Prieto, M.d.P.; Mecías-Calvo, M. Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study. Healthcare 2022, 10, 1841. https://doi.org/10.3390/healthcare10101841
Freire-Tellado M, Navarro-Patón R, Mateos-Lorenzo J, Pérez-López G, Pavón-Prieto MdP, Mecías-Calvo M. Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study. Healthcare. 2022; 10(10):1841. https://doi.org/10.3390/healthcare10101841
Chicago/Turabian StyleFreire-Tellado, Miguel, Rubén Navarro-Patón, Javier Mateos-Lorenzo, Gabina Pérez-López, María del Pilar Pavón-Prieto, and Marcos Mecías-Calvo. 2022. "Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study" Healthcare 10, no. 10: 1841. https://doi.org/10.3390/healthcare10101841