Superior outcome after out-of-hospital cardiac arrest in a two-tiered emergency medical service: A five-year survey

Objective: Outcome after out-of-hospital cardiac arrest (OHCA) is still poor in many regions worldwide. Large registries show discharge rates of about 7% corresponding to 5–6 survivors per 100,000 inhabitants/yr.1–3 It is not known exactly, if emergency medicals services (EMS) staffed by emergency physicians might improve outcome.We report data of a five-year period of a German semi-rural district with physician staffed EMS. Methods: In a prospective observational investigation all events of OHCA in the district of Marburg-Biedenkopf, state of Hesse, Germany (251,800 inhabitants, population density 199/km2) were recorded from 1.1.2008 to 31.12.2012. EMS is designed as a two-tiered system with paramedic staffed ambulances and with physician response car units staffed by an emergency physician responding to all calls with OHCA. During CPR Advanced Life Support (ALS) including endotracheal intubation,manual defibrillation and administration of intravenous epinephrine was performed. Data were recorded according to Utstein Style including outcome to hospital discharge and Cerebral Performance Category (CPC) at discharge. Data were adjusted to 100,000 inhabitants/yr. Results: In total, 919 prehospital resuscitation attempts were recorded (73/100,000 inhabitants/yr). 361 (39.2%, 28.7/100,000 inhabitants/yr)patientswereadmitted tohospital alive, 140 (15.2%, 11.1/100,000 inhabitants/yr) survived to discharge. Out of these survivors, 89 (9.5%, 7.1/100,000 inhabitants/yr) were classified to CPC 1 or 2. Conclusions: Resuscitation after OHCA in a non-urban region responded by a two-tiered EMS with presence of an emergency physician on scene andperforming full ALSproceduresmight result in superior outcome compared to systems without emergency physician or limited ALS procedures.