Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Prehospital Management of OHCA and Decisions
2.3. Study Population
2.4. Variables
2.5. Statistical Analysis
2.6. Patients and Public Involvement
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Total | Resuscitation Attempted by EP | Resuscitation Not Attempted by EP | p-Value 2 |
---|---|---|---|---|
n = 784 | n = 599 | n = 185 | ||
Patient’s sex (male), n (% 1) | 496 (63.3) | 392 (65.4) | 104 (56.2) | 0.023 |
Patient’s age (years), mean ± SD | 66.9 (±18.1) | 64.6 (±17.6) | 74.4 (±17.8) | <0.001 |
Charlson comorbidity index, n (% 1) | ||||
0 | 427 (54.5) | 341 (56.9) | 86 (46.5) | 0.001 |
1–2 | 277 (35.3) | 210 (35.1) | 67 (36.2) | |
3–4 | 38 (4.9) | 26 (4.3) | 12 (6.5) | |
5+ | 42 (5.4) | 22 (3.7) | 20 (10.8) | |
Presumed aetiology, n (% 1) | ||||
Medical (cardiac and noncardiac) | 256 (32.7) | 218 (36.4) | 38 (20.5) | 0.001 |
Trauma | 51 (6.5) | 20 (3.3) | 31 (16.8) | |
Asphyxiation (external causes) | 40 (5.1) | 35 (5.8) | 5 (2.7) | |
Unknown | 437 (55.8) | 326 (54.4) | 111 (60.0) | |
Witnessed arrest (yes), n (% 1) | 415 (52.9) | 337 (56.3) | 78 (42.2) | 0.001 |
Bystander CPR (yes), n (% 1) | 187 (23.9) | 169 (28.2) | 18 (9.7) | <0.001 |
EMS response time (min), mean ± SD | 9.2 (±4.3) | 9.2 (±4.1) | 9.3 (±4.8) | 0.869 |
EMS response time, n (% 1) | ||||
0–2 min | 24 (3.1) | 14 (2.3) | 10 (5.4) | 0.305 |
2–6 min | 100 (12.8) | 79 (76.4) | 21 (11.4) | |
6–9 min | 274 (35.0) | 212 (35.4) | 62 (33.5) | |
9–12 min | 200 (25.5) | 149 (24.9) | 51 (27.6) | |
12–25 min | 128 (16.3) | 98 (16.4) | 30 (16.2) | |
>25 min | 9 (1.2) | 6 (1.0) | 3 (1.6) | |
Missing | 49 (6.4) | 41 (6.8) | 8 (4.3) | |
Lead physician’s sex (male), n (% 1) | 488 (62.2) | 373 (62.3) | 115 (62.2) | 0.979 |
Lead physician’s experience, n (% 1) | ||||
Junior | 456 (58.2) | 353 (58.9) | 103 (55.7) | 0.282 |
Intermediate | 220 (28.1) | 160 (26.7) | 60 (32.4) | |
Senior | 108 (13.8) | 86 (14.4) | 22 (11.9) |
Variables | Unadjusted OR (95% CI) | Adjusted OR (95% CI) |
---|---|---|
Patient’s sex (male) | 1.47 (1.05–2.06) | 1.15 (0.77–1.72) |
Patient’s age (years) | ||
18–64 | Ref. | Ref. |
65–79 | 0.69 (0.44–1.07) | 0.52 (0.32–0.89) |
≥80 | 0.24 (0.16–0.36) | 0.14 (0.09–0.24) |
Charlson comorbidity index | ||
0 | Ref. | Ref. |
1–2 | 0.79 (0.55–1.14) | 0.57 (0.36–0.89) |
3–4 | 0.55 (0.26–1.13) | 0.41 (0.17–0.95) |
5+ | 0.28 (0.14–0.53) | 0.12 (0.06–0.27) |
Presumed aetiology | ||
Medical (cardiac and noncardiac) | Ref. | Ref. |
Trauma | 0.11 (0.06–0.22) | 0.04 (0.02–0.08) |
Asphyxiation (external causes) | 1.22 (0.45–3.31) | 0.75 (0.25–2.26) |
Unknown | 0.51 (0.34–0.77) | 0.55 (0.35–0.87) |
Witnessed arrest (yes) | 1.76 (1.26–2.46) | 2.14 (1.43–3.20) |
Bystander CPR (yes) | 3.65 (2.17–6.12) | 4.10 (2.28–7.39) |
EMS response time | ||
0–2 min | Ref. | Ref. |
2–6 min | 2.69 (1.05–6.90) | 2.00 (0.63–6.35) |
6–9 min | 2.44 (1.03–5.70) | 1.91 (0.65–5.56) |
9–12 min | 2.09 (0.87–4.90) | 1.48 (0.5–4.40) |
12–25 min | 2.33 (0.94–5.70) | 1.86 (0.6–5.78) |
>25 min | 1.43 (0.29–7.10) | 1.14 (0.16–8.03) |
Missing | 3.66 (1.21–11.10) | 1.95 (0.51–7.51) |
Lead physician’s sex (male) | 1.00 (0.72–1.41) | 0.99 (0.67–1.47) |
Lead physician’s experience | ||
Junior | Ref. | Ref. |
Intermediate | 0.78 (0.54–1.13) | 0.83 (0.54–1.28) |
Senior | 1.14 (0.68–1.91) | 1.31 (0.71–2.41) |
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Payot, C.; Fehlmann, C.A.; Suppan, L.; Niquille, M.; Lardi, C.; Sarasin, F.P.; Larribau, R. Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest. Int. J. Environ. Res. Public Health 2021, 18, 8323. https://doi.org/10.3390/ijerph18168323
Payot C, Fehlmann CA, Suppan L, Niquille M, Lardi C, Sarasin FP, Larribau R. Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest. International Journal of Environmental Research and Public Health. 2021; 18(16):8323. https://doi.org/10.3390/ijerph18168323
Chicago/Turabian StylePayot, Charles, Christophe A. Fehlmann, Laurent Suppan, Marc Niquille, Christelle Lardi, François P. Sarasin, and Robert Larribau. 2021. "Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest" International Journal of Environmental Research and Public Health 18, no. 16: 8323. https://doi.org/10.3390/ijerph18168323