Universität zu Köln

Boettiger, Bernd W., Bernhard, Michael, Knapp, Juergen and Nagele, Peter ORCID: 0000-0001-8369-3858 (2016). Influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation: systematic review and meta-analysis. Crit. Care, 20. LONDON: BMC. ISSN 1364-8535

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Abstract

Background: Evidence 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 Results: Studies 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-2 = 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). Conclusions: This systematic review suggests that EMS-physician-guided CPR in out-of-hospital cardiac arrest is associated with improved survival outcomes.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Boettiger, Bernd W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bernhard, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Knapp, Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED Nagele, Peter UNSPECIFIED orcid.org/0000-0001-8369-3858 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-287539
DOI:	10.1186/s13054-015-1156-6
Journal or Publication Title:	Crit. Care
Volume:	20
Date:	2016
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1364-8535
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EMERGENCY MEDICAL-SERVICES; CARDIAC LIFE-SUPPORT; ENDOTRACHEAL INTUBATION; ARREST Multiple languages Critical Care Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/28753