The impact of prehospital physicians on out-of-hospital nonasystolic cardiac arrest.

OBJECTIVE: To determine whether the presence of an on-scene medical control physician (OSMCP) alters the management and outcome of out-of-hospital nontraumatic, nonasystolic cardiac arrest (CA) patients.

METHODS: This was a retrospective case series of CA patients who were cared for in an all advanced life support, third-service, municipal emergency medical services (EMS) system over a one-year period. Excluded from the study were all traumatic CA patients and solely asystolic patients. The remaining CA patients were divided into the two study groups according to the presence of an OSMCP or whether they were cared for by paramedics only (PO). For each group patient age, EMS response time, the number of personnel on the scene, the presence of bystander CPR, the initial cardiac rhythm, and scene time were determined. In addition, time to first defibrillation for patients in ventricular fibrillation, the rate of drug administrations per minute, the return of spontaneous circulation (ROSC) on emergency department (ED) arrival, and survival to hospital discharge were collected for each group.

RESULTS: Eighty CA runs were reviewed, with 49 meeting entry criteria; nine in the OSMCP group and 40 in the PO group. There was no difference between the groups with regard to patient age, response time, scene time, or number of personnel on the scene. The two groups were similarly matched with regard to initial cardiac rhythm, the presence of bystander or first-responder CPR, and time to first defibrillation. The number of drug dosages administered per minute was higher in the OSMCP group (0.62 doses per minute) as compared with the PO group (0.34 doses per minute)[p < 0.03]. ROSC and survival to hospital discharge revealed a nonsignificant tendency toward more frequent ROSC in the OSMCP group [p < 0.07], and a significantly higher incidence of survival to discharge in the OSMCP group [p < 0.009].

CONCLUSIONS: Out-of-hospital CA patients treated in the OSMCP group had a trend toward more frequent ROSC upon ED arrival and a higher rate of survival to hospital discharge. The OSMCP group patients received medications at nearly twice the rate of the PO group patients. Although a larger trial is needed, more frequent dosing of drugs during CA may have contributed to increased survival in the OSMCP group.