General practitioner contribution to out-of-hospital cardiac arrest outcome: a national registry study
Murphy, Andrew W
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Masterson, Siobhán; Vellinga, Akke; Wright, Peter; Dowling, John; Bury, Gerard; Murphy, Andrew W (2014). General practitioner contribution to out-of-hospital cardiac arrest outcome: a national registry study. European Journal of General Practice 21 (2), 131-137
Background: There is a wide variation in reported survival from out-of-hospital cardiac arrest (OHCA). One factor in this variation may be the contribution of general practitioners to pre-hospital resuscitation. Studies using self-reported data describe increased survival proportions when general practitioners are involved. Objectives: This study aims to investigate the contribution of general practitioner involvement in out-of-hospital cardiac arrest events. Design and Setting: A retrospective observational study using data collected from ambulance records in the Republic of Ireland to describe general practitioner (GP) contribution to pre-hospital resuscitation attempts (n = 2369). Analysis is limited to patients with presumed cardiac cause and first arrest rhythm recorded as shockable (n = 510). Results: When a GP is present at scene (n = 199) patients are less likely to achieve return of spontaneous circulation (ROSC) (P &lt; 0.001) or be transported to hospital (P &lt; 0.001). When GPs participate in resuscitation (n = 92), patients are more likely to have collapsed in a public place (P &lt; 0.01), receive bystander CPR (P &lt; 0.001) and survive to hospital discharge (P &lt; 0.001). Multiple logistic analysis of survival suggests that GP participation in resuscitation increases the odds of survival (4.6; 95% CI 1.6 - 13.3) and having collapsed in a public place increases chances of survival (5.8; 95% CI 2.1 - 15.7). Conclusion: Our analysis suggests that in this subgroup, GP participation in OHCA resuscitation attempts is associated with improved patient survival. Furthermore, resuscitation is more likely to be ceased at scene when a GP is present, highlighting the role that GPs play in the compassionate management of death in unviable circumstances.