Influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation: systematic review and meta-analysisReport as inadecuate




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Critical Care

, 20:4

First Online: 09 January 2016Received: 29 April 2015Accepted: 06 December 2015

Abstract

BackgroundEvidence suggests that EMS-physician-guided cardiopulmonary resuscitation CPR in out-of-hospital cardiac arrest OOHCA may be associated with improved outcomes, yet randomized controlled trials are not available. The goal of this meta-analysis was to determine the association between EMS-physician- versus paramedic-guided CPR and survival after OOHCA.

Methods and ResultsStudies that compared EMS-physician- versus paramedic-guided CPR in OOHCA published until June 2014 were systematically searched in MEDLINE, EMBASE and Cochrane databases. All studies were required to contain survival data. Data on study characteristics, methods, and as well as survival outcomes were extracted. A random-effects model was used for the meta-analysis due to a high degree of heterogeneity among the studies I = 44 %. Return of spontaneous circulation ROSC, survival to hospital admission, and survival to hospital discharge were the outcome measures.

Out of 3,385 potentially eligible studies, 14 met the inclusion criteria. In the pooled analysis n = 126,829, EMS-physician-guided CPR was associated with significantly improved outcomes compared to paramedic-guided CPR: ROSC 36.2 % 95 % confidence interval CI 31.0 – 41.7 % vs. 23.4 % 95 % CI 18.5 – 29.2 % pooled odds ratio OR 1.89, 95 % CI 1.36 – 2.63, p < 0.001; survival to hospital admission 30.1 % 95 % CI 24.2 – 36.7 % vs. 19.2 % 95 % CI 12.7 – 28.1 % pooled OR 1.78, 95 % CI 0.97 – 3.28, p = 0.06; and survival to discharge 15.1 % 95 % CI 14.6 – 15.7 % vs. 8.4 % 95 % CI 8.2 – 8.5 % pooled OR 2.03, 95 % CI 1.48 – 2.79, p < 0.001.

ConclusionsThis systematic review suggests that EMS-physician-guided CPR in out-of-hospital cardiac arrest is associated with improved survival outcomes.

KeywordsCardiac arrest Cardiopulmonary resuscitation Outcomes Emergency medical service physicians Paramedics AbbreviationsCIConfidence interval

CPRCardiopulmonary resuscitation

EMSEmergency medical service

MOOSEMeta-analysis Of Observational Studies in Epidemiology

OOHCAOut-of-hospital cardiac arrest

OROdds ratio

PRISMAPreferred Reporting Items for Systematic reviews and Meta-Analyses

ROSCReturn of spontaneous circulation

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-015-1156-6 contains supplementary material, which is available to authorized users.

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Author: Bernd W. Böttiger - Michael Bernhard - Jürgen Knapp - Peter Nagele

Source: https://link.springer.com/







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