Association of emergency physician critical care training on outcomes after non-traumatic out-of-hospital cardiac...

In physician-staffed emergency medical services (EMS) systems, emergency physicians may differ in postgraduate specialist and critical care training. Whether such differences are associated with outcomes after out-of-hospital cardiac arrest (OHCA) remains uncertain. We investigated the association between emergency physician qualification and outcomes after non-traumatic OHCA.

This retrospective cohort study included adult patients with non-traumatic OHCA from the Marburg-Biedenkopf EMS region from 2018 to 2024. Patients were treated by residents, specialists without additional critical care training, or specialists with additional critical care training. The primary outcome was survival to discharge. Secondary outcomes included return of spontaneous circulation (ROSC), hospital admission with ROSC, 24-h survival, and favorable neurological outcome. Multivariable logistic regression was performed for each endpoint with residents as reference.

Among 1426 patients, any ROSC did not differ significantly between groups (39.9%, 42.5%, and 45.7%; p = 0.211). Operational response times and time to first ROSC were comparable. Specialists with additional critical care training achieved faster vascular access and earlier vasopressor administration, with fewer access failures. Survival to discharge increased across groups (12.2%, 14.4%, and 18.0%; p = 0.047). In adjusted analyses, specialists with additional critical care training had higher odds of hospital admission with ROSC (OR 1.42, 95% CI 1.05-1.93) and survival to discharge (OR 1.59, 95% CI 1.05-2.40) compared with residents.

Additional critical care training was associated with selected prehospital procedural measures and higher odds of hospital admission with ROSC and survival to discharge. These observational findings are hypothesis-generating and do not establish causality.