Does experience in prehospital post-resuscitation critical care affect outcomes? A retrospective cohort study.

Aims of the study Helicopter Emergency Medical Services (HEMS) often provide post-resuscitation care. Our aims were to investigate whether physicians' frequent exposure to prehospital post-resuscitation care is associated with differences in 1) medical management 2) achieving treatment targets recommended by resuscitation guidelines 3) survival. Methods We conducted a retrospective cohort study using data from a national HEMS quality register. We included patients between January 1st , 2012 and September 9th , 2019 who received post-resuscitation care by a HEMS physician. We excluded patients <16 years old. For each patient we determined the number of post-resuscitation cases the physician had attended in the previous 12 months. Patients were divided in to three groups: low (0-5), intermediate (6-11) and high exposure (≥12 cases). Medical management and proportions within treatment targets were compared. Survival at 30-days and 1-year was analysed by multivariate logistic regression analysis, controlling for known prognostic factors. Results 2272 patients were analysed. Patients in the high exposure group had mechanical ventilation and vasoactive medications initiated more often (P<0.001 and P=0.008, respectively) and on-scene times were longer (P<0.001). The target for blood pressure was achieved more often in this group (P=0.026), but targets for oxygenation and ventilation were not. We did not see an association between survival and physicians' exposure to post-resuscitation care (odds ratio 0.96, 95% confidence interval 0.70-1.33 for low and 0.78, 0.56-1.08 for intermediate, compared to high exposure). Conclusions Physicians with more, frequent exposure take a more active approach to post-resuscitation care, but this doesn't seem to improve survival.