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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2015 | Research

Influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation: systematic review and meta-analysis

Authors: Bernd W. Böttiger, Michael Bernhard, Jürgen Knapp, Peter Nagele

Published in: Critical Care | Issue 1/2016

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Abstract

Background

Evidence suggests that EMS-physician-guided cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OOHCA) may be associated with improved outcomes, yet randomized controlled trials are not available. The goal of this meta-analysis was to determine the association between EMS-physician- versus paramedic-guided CPR and survival after OOHCA.

Methods and Results

Studies that compared EMS-physician- versus paramedic-guided CPR in OOHCA published until June 2014 were systematically searched in MEDLINE, EMBASE and Cochrane databases. All studies were required to contain survival data. Data on study characteristics, methods, and as well as survival outcomes were extracted. A random-effects model was used for the meta-analysis due to a high degree of heterogeneity among the studies (I 2  = 44 %). Return of spontaneous circulation [ROSC], survival to hospital admission, and survival to hospital discharge were the outcome measures.
Out of 3,385 potentially eligible studies, 14 met the inclusion criteria. In the pooled analysis (n = 126,829), EMS-physician-guided CPR was associated with significantly improved outcomes compared to paramedic-guided CPR: ROSC 36.2 % (95 % confidence interval [CI] 31.0 – 41.7 %) vs. 23.4 % (95 % CI 18.5 – 29.2 %) (pooled odds ratio [OR] 1.89, 95 % CI 1.36 – 2.63, p < 0.001); survival to hospital admission 30.1 % (95 % CI 24.2 – 36.7 %) vs. 19.2 % (95 % CI 12.7 – 28.1 %) (pooled OR 1.78, 95 % CI 0.97 – 3.28, p = 0.06); and survival to discharge 15.1 % (95 % CI 14.6 – 15.7 %) vs. 8.4 % (95 % CI 8.2 – 8.5 %) (pooled OR 2.03, 95 % CI 1.48 – 2.79, p < 0.001).

Conclusions

This systematic review suggests that EMS-physician-guided CPR in out-of-hospital cardiac arrest is associated with improved survival outcomes.
Appendix
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Metadata
Title
Influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation: systematic review and meta-analysis
Authors
Bernd W. Böttiger
Michael Bernhard
Jürgen Knapp
Peter Nagele
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-1156-6

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