The Contributions of Emergency Physicians to Out-of-hospital Cardiopulmonary Arrest: An Analysis of the National Utstein Registry Data

BackgroundEmergency 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.ObjectiveWe assessed the impact of the number of emergency physicians on the outcomes of OHCA.MethodsIn 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.ResultsDuring 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).ConclusionAn increased number of emergency physicians/100,000 population is likely to be associated with improved outcomes.