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Scientific article
Open access
English

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

Publication date2021-08-06
First online date2021-08-06
Abstract

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP's decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

eng
Keywords
  • Charlson comorbidity index
  • Advanced life support
  • Asystole
  • Emergency medical service
  • Emergency physician
  • Medical decision
  • Out-of-hospital cardiac arrest
  • Prehospital emergency
Citation (ISO format)
PAYOT, Charles et al. Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest. In: International journal of environmental research and public health, 2021, vol. 18, n° 16, p. 8323. doi: 10.3390/ijerph18168323
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Article (Published version)
Identifiers
ISSN of the journal1660-4601
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Technical informations

Creation09/23/2021 7:01:00 PM
First validation09/23/2021 7:01:00 PM
Update time03/16/2023 1:34:33 AM
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