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Advanced rescuer- versus citizen-witnessed cardiac arrest: Is there a difference in outcome?
MedLine Citation:
PMID:  20836699     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Substantial financial and human resources are invested in training and maintaining advanced life support (ALS) skills of paramedics who are deployed to the field in response to out-of-hospital cardiac arrest. It would be expected that patients who experience cardiac arrest in the presence of a trained health care practitioner, such as a paramedic, have better outcomes.
OBJECTIVE: To compare the rates of return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD) between paramedic-witnessed out-of-hospital cardiac arrest vs. citizen-witnessed out-of-hospital cardiac arrest.
METHODS: In this retrospective cohort study, the records of all out-of-hospital nontraumatic cardiac arrest patients presenting to a municipal teaching hospital from November 1, 1994, through June 30, 2008, were reviewed. The age, gender, race, rhythm on paramedic arrival, presence of bystander cardiopulmonary resuscitation (CPR), whether it was a witnessed arrest and, if witnessed, whether it was a paramedic-witnessed arrest, site of the arrest, and the rate of SHD were noted. A univariate odds ratio was computed to describe the association between paramedic-witnessed out-of-hospital cardiac arrest vs.citizen-witnessed out-of-hospital cardiac arrest and SHD. A multivariable logistic regression analysis was also performed, controlling for age, gender, arrest rhythm, bystander CPR, and site of arrest.
RESULTS: Of the total cohort of 1,294 out-of-hospital cardiac arrests, 750 (52.6%) were either paramedic-witnessed (154/750 = 20.5%) or citizen-witnessed (596/750 = 79.5%). Among the witnessed cardiac arrests, overall the SHD was 53 of 750 (7.1%). On univariate analysis, the ROSC, SHA, or SHD rates were not statistically significantly different between paramedic- and citizen-witnessed arrests. Even after multivariable adjustment, the ROSC, SHA, and SHD rates were not significantly different between paramedic- and citizen-witnessed arrests.
CONCLUSIONS: Among our study population of out-of-hospital cardiac arrest victims, paramedic-witnessed arrests did not appear to have improved survival rates when compared with citizen-witnessed arrests.
Amy H Kaji; Arslan M Hanif; James T Niemann
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-09-13
Journal Detail:
Title:  Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors     Volume:  15     ISSN:  1545-0066     ISO Abbreviation:  Prehosp Emerg Care     Publication Date:    2011 Jan-Mar
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-06-02     Revised Date:  2012-04-04    
Medline Journal Info:
Nlm Unique ID:  9703530     Medline TA:  Prehosp Emerg Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  55-60     Citation Subset:  IM    
Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.
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MeSH Terms
Aged, 80 and over
Cardiopulmonary Resuscitation / statistics & numerical data*
Confidence Intervals
Emergency Medical Services
Emergency Medical Technicians / statistics & numerical data*
Logistic Models
Middle Aged
Multivariate Analysis
Odds Ratio
Out-of-Hospital Cardiac Arrest / mortality,  therapy*
Retrospective Studies
Statistics as Topic
Treatment Outcome*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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