The impact of additional special emergency medical service units on non-traumatic adult out-of-hospital cardiac arrest outcomes in a high-resource metropolitan area

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2025-07-25 DOI:10.1016/j.resplu.2025.101046

Andrea Kornfehl , Mario Krammel , Daniel Grassmann , Maximilian de Zordo , Roman Brock , Christoph Veigl , Rene Adler , Sabine Dunkl , Mathias Gatterbauer , Philipp Gonzo , Bertram Schadler , Patrick Aigner , Michael Girsa , Patrick Glaninger , Andreas Zajicek , Patrick Sulzgruber , Thomas Uray , Sebastian Schnaubelt

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Abstract

Background

Out-of-hospital cardiac arrest (OHCA) requires an effective cardiopulmonary resuscitation (CPR) and emergency medical service (EMS) response, yet survival rates remain low at 8.0–11.3 %. Factors such as team size, training and leadership influence outcomes, but optimal strategies are debated. The Vienna EMS routinely deploys field supervisors (FISU) to improve the quality of care. The aim of this study was to assess their impact on OHCA outcomes.

Methods

This retrospective observational study analyzed all consecutive adult non-traumatic OHCA cases in Vienna between 01/2019 and 12/2023, focusing on the impact of additional specialised units (FISU or supervising senior emergency physician) on cardiac arrest outcomes (ROSC rates, survival to hospital discharge, neurological performance). Statistical analysis used descriptive statistics, group tests, and logistic regression.

Results

A FISU was present in 45.7 % of cases, and its presence improved outcomes significantly including any ROSC (40.6 % vs 26.3 %; OR 1.963, CI 1.773–2.172, p < 0.001), survived event (sustained ROSC) (30.6 % vs 20.6 %; OR 1.720, CI 1.542–1.918, p < 0.001), survival to discharge (10.6 % vs 8.3 %; OR 1.263, 1.072–1.487, p = 0.005) and CPC 1/2 (7 % vs 6.4 %; OR 1.034, CI 1.152–1.253, p = 0.037). Multivariate analysis confirmed that the presence of FISU had an independently positive effect (any ROSC: OR 1.616, CI 1.440–1.813, p < 0.001; survived event: OR 1.335, CI 1.180–1.510, p < 0.001).

Conclusions

The presence of additional EMS special units like field supervisors can improve outcomes of non-traumatic out-of-hospital cardiac arrest in a high-resource metropolitan area.

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在资源丰富的大都市地区，增加特殊紧急医疗服务单位对非创伤性成人院外心脏骤停结果的影响

院外心脏骤停（OHCA）需要有效的心肺复苏（CPR）和紧急医疗服务（EMS）响应，但生存率仍然很低，为8.0% - 11.3%。团队规模、培训和领导力等因素都会影响结果，但最佳策略仍存在争议。维也纳紧急医疗服务中心定期部署现场监督员（FISU），以提高护理质量。本研究的目的是评估它们对OHCA结果的影响。方法本回顾性观察性研究分析了2019年1月1日至2023年12月在维也纳连续发生的所有成人非创伤性OHCA病例，重点研究了额外专科病房（FISU或监督高级急诊医生）对心脏骤停结局（ROSC率、存活至出院、神经功能）的影响。统计分析采用描述性统计、组检验和逻辑回归。结果45.7%的病例存在sa FISU，其存在可显著改善预后，包括任何ROSC (40.6% vs 26.3%；OR 1.963, CI 1.773-2.172, p <；0.001)，存活事件（持续ROSC） (30.6% vs 20.6%；OR 1.720, CI 1.542-1.918, p <；0.001)，存活至出院(10.6% vs 8.3%；1.072或1.263,-1.487,p = 0.005)和中国共产党1/2 (7% vs 6.4%;OR 1.034, CI 1.152 ~ 1.253, p = 0.037)。多因素分析证实，FISU的存在具有独立的积极作用(任何ROSC: OR 1.616, CI 1.440-1.813, p <；0.001;存活事件：OR 1.335, CI 1.180-1.510, p <；0.001)。结论在资源丰富的大都市地区，现场监护等额外的EMS特殊单位的存在可以改善非创伤性院外心脏骤停的预后。

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