Abstract
Background
Emergency physicians are likely to play an important role in the “chain of survival.”
The relationship between the number of emergency physicians and out-of-hospital cardiopulmonary
arrest (OHCA) prognosis is not well understood.
Objective
We assessed the impact of the number of emergency physicians on the outcomes of OHCA.
Methods
In a nationwide, population-based, observational study, we enrolled 120,721 adults
aged ≥18 years with OHCA, from January 1, 2010 to December 31, 2010. We used the countrywide
Utstein Registry database coupled with health statistics data surveyed by the Ministry
of Health, Labour and Welfare. The primary endpoint was favorable neurological outcomes
1 month after OHCA.
Results
During the study period, OHCA occurred in 25,580 people (21.2%) in an area with the
number of emergency physicians/100,000 population <1.5, in 62,299 people (51.6%) in
an area with ≥1.5 and <3.0 emergency physicians/100,000 population, in 30,948 people
(25.6%) in an area with ≥3.0 and <4.5 emergency physicians/100,000 population, and
in 1894 people (1.6%) in an area with ≥4.5 emergency physicians/100,000 population.
Patient prognosis became more favorable as the number of emergency physicians increased
(1-month survival: 5.08% vs. 5.81% vs. 5.90% vs. 8.82%, p < 0.0001; and favorable neurological outcomes: 2.64% vs. 2.84% vs. 3.23% vs. 3.54%,
p < 0.0001; for emergency physicians/100,000 population of <1.5, ≥1.5 and <3.0, ≥3.0
and <4.5, and ≥4.5, respectively). The adjusted odds ratio for favorable neurological
outcomes per increase of one emergency physician/100,000 population was 1.06 (95%
confidence interval 1.01–1.11, p = 0.0163).
Conclusion
An increased number of emergency physicians/100,000 population is likely to be associated
with improved outcomes.
Keywords
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References
- The current state of emergency and rescue, 2013 edition.([Japanese]) Fire and Disaster Management Agency, Ministry of Internal Affairs and Communications, Tokyo2013
- Incidence of EMS-treated out-of-hospital cardiac arrest in Europe.Resuscitation. 2005; 67: 75-80
- Heart disease and stroke statistics—2012 update: a report from the American Heart Association.Circulation. 2012; 125: e2-e220
- Temporal trends in sudden cardiac arrest: a 25-year emergency medical services perspective.Circulation. 2003; 107: 2780-2785
- Factors associated with survival to hospital discharge among patients hospitalized alive after out of hospital cardiac arrest: change in outcome over 20 years in the community of Göteberg, Sweden.Heart. 2003; 89: 25-30
- Part 4: CPR overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2010; 122: S676-S684
- Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2010; 122: S768-S786
- Long-term prognosis following resuscitation from out of hospital cardiac arrest: role of percutaneous coronary intervention and therapeutic hypothermia.J Am Coll Cardiol. 2012; 60: 21-27
- Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis.Lancet. 2008; 372: 554-561
- Utstein style study of cardiopulmonary bypass after cardiac arrest.Am J Emerg Med. 2008; 26: 649-654
- Receiving hospital characteristics associated with survival after out-of-hospital cardiac arrest.Resuscitation. 2010; 81: 524-529
- Hospital characteristics are associated with patient outcomes following out-of-hospital cardiac arrest.Heart. 2011; 97: 1489-1494
- Increasing hospital volume is not associated with improved survival in out of hospital cardiac arrest of cardiac etiology.Resuscitation. 2012; 83: 862-868
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerica Heart Foundation, Resuscitation Councils of Southern Africa).Circulation. 2004; 110: 3385-3397
- Japan statistical yearbook 2013.Statistics Bureau, Ministry of Internal Affairs and Communications, Tokyo2013
- Impact of seasonal temperature environment on the neurological prognosis of out-of-hospital cardiac arrest: a nationwide, population-based cohort study.J Crit Care. 2014; 29: 840-847
- Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest.JAMA. 2013; 309: 257-266
- Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study.Lancet. 2010; 375: 1347-1354
- Nationwide public-access defibrillation in Japan.N Engl J Med. 2010; 362: 994-1004
- Health care costs related to out-of-hospital cardiopulmonary arrest in Japan.Resuscitation. 2013; 84: 964-969
- Predictors of favorable and poor prognosis in unwitnessed out-of-hospital cardiac arrest with a non-shockable initial rhythm.Int J Cardiol. 2014; 176: 910-915
- JRC guidelines 2010.Japan Resuscitation Council, Tokyo2012
- Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2010; 122: S640-S656
- Part 1: executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.Resuscitation. 2010; 81: e1-e25
- Application of cerebral oxygen saturation to prediction of the futility of resuscitation for out-of-hospital cardiopulmonary arrest patients: a single-center, prospective, observational study.Am J Emerg Med. 2014; 32: 747-751
- Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council.Circulation. 1991; 84: 960-975
- Survey of medical institutions 2010.([Japanese]) Ministry of Health, Labour and Welfare, Tokyo2010
- Survey of physicians, dentists and pharmacists 2010.([Japanese]) Ministry of Health, Labour and Welfare, Tokyo2010
- Evaluation of tertiary emergency medical centers 2010.([Japanese]) Ministry of Health, Labour and Welfare, Tokyo2011
- Current state of emergency and rescue, 2010 edition.([Japanese]) Fire and Disaster Management Agency, Ministry of Internal Affairs and Communications, Tokyo2010
- White paper on fire service, 2010 edition.([Japanese]) Fire and Disaster Management Agency, Ministry of Internal Affairs and Communications, Tokyo2010
- G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behav Res Methods. 2007; 39: 175-191
- Targeted temperature management at 33°C versus 36°C after cardiac arrest.N Engl J Med. 2013; 369: 2197-2206
- Intra-arrest hypothermia during cardiac arrest: a systematic review.Crit Care. 2012; 16: R41
Article info
Publication history
Published online: January 21, 2015
Accepted:
September 30,
2014
Received in revised form:
September 7,
2014
Received:
April 23,
2014
Footnotes
The Institutional Review Board of the University of Tokyo approved the study.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
