Traumatic out-of-hospital cardiac arrest (OHCA) patients who received advanced life support (ALS) from physicians in a pre-hospital setting achieved better outcomes than patients who received ALS by emergency medical service personnel or basic life support (BLS), according to a cohort study from the Japanese National Registry presented Saturday during the Resuscitation Science Symposium.
Tatsuma Fukuda, MD, PhD, from the University of Ryukyus in Okinawa, Japan, presented the population-based study that included 4,382 patients who experienced OHCA following a traffic accident in Japan from 2013 to 2014. The primary outcome was one-month survival.
If a patient received at least one ALS procedure — for example, intravenous line insertion, epinephrine administration or advanced airway management — the patient was assigned to the ALS group. Patients in the BLS group did not receive any ALS procedures.
In the study cohort, 828 patients received physician-performed ALS; 1,591 received pre-hospital ALS by EMS personnel; and 1,963 patients received BLS only. Of all patients in the study, 2.2 percent survived one month after OHCA, including 3.1 percent treated with ALS by a physician, 1.6 percent with ALS from EMS and 2.3 percent who received BLS.
Multivariable analysis showed that physician-administered ALS resulted in about twice the chance for one-month survival compared with both ALS by EMS and BLS (adjusted odds ratio=2.13; 95 percent CI, 1.20-3.78; and adjusted OR=1.94; 95 percent CI, 1.14-3.25). There was no significant difference in one-month survival between the ALS by EMS and BLS groups.
According to Fukuda, there are several reasons that could explain the advantages of physician-performed ALS. All EMS personnel in Japan perform CPR according to the Japanese CPR guidelines, although EMS personnel have different authorization levels depending on their level of training.
A small percentage of municipalities have physician-staffed ambulances, but most ambulances include at least one emergency life-saving technician (ELST) certified to insert an intravenous line and a supraglottic airway device. Specially trained ELST who have completed an extensive training program can administer epinephrine and insert an endotracheal tube.
“There might be differences in proficiency in ALS procedures between physicians and EMS personnel,” Fukuda said. “In addition, the interventions, which only physicians could perform — surgical airway, chest drain, pericardial drain or thoracotomy — might have a greater impact on survival after traumatic OHCA. Unfortunately, the information on such interventions could not be obtained from the Japanese OHCA registry data.”