Fukuda T, et al. - Researchers evaluated if prehospital advanced life support (ALS) should be provided for traumatic out-of-hospital cardiac arrest (OHCA) and who should perform it. ALS by physician in traumatic OHCA was related to increased chance of 1-month survival vs both ALS by emergency medical service (EMS) personnel and basic life support (BLS).

Methods

• Experts analyzed the Japanese government-managed nationwide population-based registry data of patients with OHCA transported to an Emergency Hospital.
• They included the patients who experienced traumatic OHCA following a traffic collision from 2013 to 2014.
• They compared the patients provided prehospital ALS by a physician with both patients provided ALS by EMS personnel and patients with only BLS.
• On May 1, 2017, the data were analyzed.
• One-month survival was the primary outcome.
• Prehospital return of spontaneous circulation and favorable neurologic outcomes with the Glasgow-Pittsburgh cerebral performance category score of 1 or 2 were the secondary outcomes.

Results

• A total of 4,382 patients were included (mean [SD] age, 57.5 [22.2] years; 67.9% male); 828 (18.9%) received prehospital ALS by physician, 1,591 (36.3%) received prehospital ALS by EMS personnel, and 1,963 (44.8%) received BLS only.
• Among these patients, 96 (2.2%) survived 1 month after OHCA, including 26 of 828 (3.1%) for ALS by physician, 25 of 1,591 (1.6%) for ALS by EMS personnel, and 45 of 1,963 (2.3%) for BLS.
• Results demonstrated that, after adjusting for potential confounders using multivariable logistic regression, ALS by physician was significantly associated with higher odds for 1-month survival vs both ALS by EMS personnel and BLS (adjusted OR, 2.13; 95% CI, 1.20-3.78; and adjusted OR, 1.94; 95% CI, 1.14-3.25; respectively), while ALS by EMS personnel and BLS demonstrated no significant difference (adjusted OR, 0.91; 95% CI, 0.54-1.51).
• A propensity score–matched analysis in the ALS cohort demonstrated that, compared with ALS by EMS personnel, ALS by physician was related to an increased chance of 1-month survival (risk ratio, 2.00; 95% CI, 1.01-3.97; P=.04).
• Across a variety of sensitivity analyses, this association was consistent.