[Emergency physician interventions in the care of patients with acute coronary syndrome : Comparative, retrospective,...

The prehospital emergency care of patients with acute coronary syndrome (ACS) is highly relevant as such interventions have required an above-average involvement of emergency physicians to date. The aim of this study was to investigate the incidence of physicians' interventions in the context of ACS care and to identify predictors that indicate the need for such interventions at the time of the emergency call.

A retrospective observational study was conducted based on 10,833 emergency department protocols from three regions in Germany. Protocols with (suspected) diagnoses such as STEMI, NSTEMI, unclear chest pain, or cardiogenic shock were included. After extensive data cleaning and coding of interventions, a descriptive analysis was performed to determine the incidence of physicians' measures and a logistic regression to determine predictors for physicians' interventions.

Interventions requiring the presence of an emergency physician were performed in 2.5% of cases. Significant predictors for physicians' interventions were undocumented (odds ratio [OR] 2.7), reduced (OR 7.77) or absent consciousness (OR 24.5), undocumented breathing (OR 5.13), dyspnea (OR 2.1), cyanosis (OR 4.48), apnea (OR 8.82) or cold sweats (OR 3.2).

The incidence of physicians' interventions in ACS patients is low. The results suggest that not all ACS cases require physicians on scene. However, patients with reduced consciousness, cyanosis or respiratory arrest should continue to be treated primarily by emergency physicians. Prospective studies could further improve prehospital care.