Related Experiment Video
Updated: Sep 1, 2025
07:18
Author Spotlight: A Unique Mouse Model of Asphyxia-Induced Cardiac Arrest
Published on: April 14, 2023
1.9K
Utilization and Effect of Direct Medical Oversight during Out-of-Hospital Cardiac Arrest
Tristen M Zimmerman1, Matthew R Neth1, Mary E Tanski1
1Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon.
Prehospital Emergency Care
|August 17, 2022
Summary
Direct medical oversight (DMO) in out-of-hospital cardiac arrests (OHCA) rarely leads to survival. Most patients receiving DMO have poor prognoses, suggesting potential for reduced unnecessary transports and DMO contacts.
Area of Science:
- Emergency Medicine
- Cardiology
- Public Health
Background:
- Direct medical oversight (DMO) is a common practice in US emergency medical services (EMS) for real-time physician guidance.
- Characterizing DMO recommendations during out-of-hospital cardiac arrests (OHCA) is crucial for understanding its impact on patient care and outcomes.
Purpose of the Study:
- To analyze DMO recommendations during OHCA events.
- To evaluate the effect of DMO on EMS transport decisions and patient survival rates.
Main Methods:
- Secondary analysis of DMO call recordings from OHCA cases in Portland, Oregon (2018-2021).
- Data linked to the Portland Cardiac Arrest Epidemiologic Registry (PDX Epistry).
- Primary outcomes: DMO recommendations (transport, field resuscitation, termination of resuscitation [TOR]). Secondary outcomes: transport decisions, survival to admission/discharge.
Main Results:
- EMS requested TOR for 72% of 239 OHCA cases.
- DMO recommended transport, continued resuscitation, or TOR in 21.8%, 18.0%, and 60.2% of cases, respectively.
- Only 1 of 239 patients survived to hospital discharge with good neurologic outcome.
Conclusions:
- OHCA patients receiving DMO, particularly those with poor prognostic signs or requesting TOR, have very low survival rates.
- Findings suggest potential for reducing unnecessary DMO contact and patient transports.
- Further research is needed to identify OHCA patients who benefit from DMO contact.
More Related Videos
Related Concept Videos
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
65
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
65
01:23Cardiopulmonary Resuscitation III: AED Use
58
Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
58
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
81
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
81
01:21Cardiopulmonary Resuscitation I: Adult
51
Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
51
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
26
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
26
01:28Acute Coronary Syndrome IV: Interprofessional Care
23
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
23