Effects of physician-present prehospital care in patients with out-of-hospital cardiac arrest on return of spontaneous circulation: A retrospective, observational study in Saga, Japan

Background and AimsEmergency medical services for out-of-hospital cardiac arrest (OHCA) vary according to region and country, and patient prognosis differs accordingly. In Japan, physicians may provide prehospital care. However, the effect of physician-present prehospital care on achieving return of spontaneous circulation (ROSC) in patients with cardiac arrest is not clear. Here, we aimed to examine the effect of physician-present prehospital care on the prognosis of patients with OHCA at our hospital compared with physician-absent care.MethodsIn this retrospective, observational study, patients aged >= 18 years with non-traumatic OHCA from a single center in Saga City, Japan, between April 2011 and December 2019, were included. Patients were divided into two groups, based on prehospital physician presence or absence. Logistic regression analysis was used to determine the association between physician-present prehospital care and ROSC.ResultsOf 820 patients with OHCA, 151 had a physician present and 669 did not. Logistic regression analysis with no adjustment showed that the odds ratio (OR) of physician-present prehospital care for an increased ROSC rate was 1.74 (95% confidence interval [CI]: 1.22-2.48, p = 0.002). Logistic-regression analysis adjusted for ROSC-related factors indicated an OR of 1.05 (95% CI: 0.47-2.34, p = 0.914) for physician-present prehospital care to ROSC.ConclusionPhysician-present prehospital care may not necessarily lead to increased ROSC rates. However, insufficient data limited our study findings. Further studies involving larger sample sizes are warranted. We examined the effects of physician-present prehospital care on the prognosis of patients with out-of-hospital cardiac arrest (OHCA) compared with physician-absent care. Physician-present prehospital care was not necessarily helpful in achieving the return of spontaneous circulation (ROSC) when adjusting for all influencing factors. The 95% confidence interval of physician-present prehospital care to ROSC straddled 1 when adjusted for factors such as prehospital advanced airway usage, prehospital epinephrine administration, and on-site operation time.