Limited evidence exists regarding whether advanced airway management (AAM) performed in the pre-hospital phase with a physician on scene leads to better outcomes after cardiac arrest than AAM delivered without physician involvement. This retrospective, multicentre cohort investigation included consecutive patients transported to participating Japanese hospitals after experiencing out-of-hospital cardiac arrest between 1 June 2014 and 31 December 2019. Eligible individuals were those aged 18 years or older, with presumed medical causes, who received pre-hospital AAM and were resuscitated upon hospital arrival. The primary endpoint—referred to as one-month favourable neurological survival—was defined as a Cerebral Performance Category (CPC) score of 1 or 2 one month after the arrest. The initial cardiac rhythm was determined using a 3-lead ECG or an automated external defibrillator in combination with carotid pulse checks. Prior work has suggested that physician involvement before hospital arrival may improve outcomes once rhythm type is accounted for ([1–4]). Consequently, the initial rhythm was classified as shockable or non-shockable. Multivariable logistic regression was conducted following propensity score matching. A total of 16,703 cases were evaluated. In the non-shockable cohort (n = 2,346), 1.2% (N = 29) reached the primary outcome. The adjusted odds ratio (aOR) for the effect of physician-attended versus non-physician AAM on the primary outcome in this group was 4.64 (95% CI: 1.81–14.4). In the shockable cohort (n = 826), 16.9% (N = 140) achieved favourable neurological survival, with an aOR of 1.05 (95% CI: 0.67–1.63). Within this multicentre retrospective cohort, the presence of a physician during pre-hospital AAM was significantly associated with better neurological outcomes in specific subsets of cardiac arrest patients compared with AAM conducted without a physician present.
