Background Should all out‐of‐hospital cardiac arrest ( OHCA ) patients be directly transported to cardiac arrest centers ( CAC s) remains under debate. Our study evaluated the impacts of different transport time and destination hospital on the outcomes of OHCA patients. Methods and Results Data were collected from 6655 OHCA patients recorded in the regional prospective OHCA registry database of Taoyuan City, Taiwan, between January 2012 and December 2016. Patients were matched on propensity score, which left 5156 patients, 2578 each in the CAC and non‐ CAC groups. Transport time was dichotomized into <8 and ≥8 minutes. The relations between the transport time to CAC s and good neurological outcome at discharge and survival to discharge were investigated. Of the 5156 patients, 4215 (81.7%) presented with nonshockable rhythms and 941 (18.3%) presented with shockable rhythms. Regardless of transport time, transportation to a CAC increased the likelihoods of survival to discharge (<8 minutes: adjusted odds ratio [aOR], 1.95; 95% CI, 1.11–3.41; ≥8 minutes: aOR, 1.92; 95% CI, 1.25–2.94) and good neurological outcome at discharge (<8 minutes: aOR, 2.70; 95% CI, 1.40–5.22; ≥8 minutes: aOR, 2.20; 95% CI, 1.29–3.75) in OHCA patients with shockable rhythms but not in patients with nonshockable rhythms. Conclusions OHCA patients with shockable rhythms transported to CAC s demonstrated higher probabilities of survival to discharge and a good neurological outcome at discharge. Direct ambulance delivery to CAC s should thus be considered, particularly when OHCA patients present with shockable rhythms.

chip-Jin ng 1 ✉ cardiopulmonary resuscitation (cpR) training and its quality are critical in improving the survival rate of cardiac arrest. This randomized controlled study investigated the efficacy of a newly developed CPR training program for the public in a Taiwanese setting. A total of 832 adults were randomized to either a traditional or blended (18-minute e-learning plus 30-minute hands-on) compression-only CPR training program. The primary outcome was compression depth. Secondary outcomes included CPR knowledge test, practical test, quality of CPR performance, and skill retention. The mean compression depth was 5.21 cm and 5.24 cm in the blended and traditional groups, respectively. The mean difference in compression depth between groups was −0.04 (95% confidence interval −0.13 to infinity), demonstrating that the blended CPR training program was non-inferior to the traditional CPR training program in compression depth after initial training. Secondary outcome results were comparable between groups. Although the mean compression depth and rate were guideline-compliant, only half of the compressions were delivered with adequate depth and rate in both groups. CPR knowledge and skill retained similarly in both groups at 6 and 12 months after training. The blended CPR training program was non-inferior to the traditional CPR training program. However, there is still room for improvement in optimizing initial skill performance as well as skill retention. Clinical Trial Registration: NCT03586752; www.clinicaltrial.gov The survival rate of out-of-hospital cardiac arrest (OHCA) is low. In the United States, it has remained between 7% and 9% for the past decades 1. Meanwhile the 180-day OHCA survival rate was reported to be 9.8% in Taiwan 2. Early defibrillation is a treatment option that can increase OHCA survival rate and survival outcomes 3. Ever since its promotion by the American Heart Association (AHA) 4 , many countries have installed automated external defibrillators (AEDs) in public or private places including tourists spots, shopping malls, airports, casinos, schools, offices and so forth, with increased coverage and accessibility. In Taiwan, up until 2017, a total of 8334 AEDs had been installed nationwide 5. Wang et al. 5 reported that, among the documented OHCA cases with AEDs used, 35% were known to be operated by the employees at the designated AED locations, and long-term care facilities had the highest utilization rate of AED. In addition, high-quality chest compressions during cardiopulmonary resuscitation (CPR) also improve OHCA patient outcomes 6-8. However, studies have shown the quality of CPR to be substandard 9,10. Therefore, training with a focus on cardiopulmonary resuscitation (CPR) quality and AED should be implemented and provided, particularly at the AED locations of high cardiac arrest frequency.

Purpose Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) is an emerging contagious pathogen that has caused community and nosocomial infections in many countries. This study aimed to evaluate the impact of Coronavirus disease 2019 (COVID-19) on emergency services of the largest medical center in Taiwan by comparing emergency department (ED) usage, turnover, and admission rates before the COVID-19 outbreak with those during the outbreak. Materials and Methods A retrospective cohort study was conducted in the ED of the largest tertiary medical center in Taiwan. Trends of adult, non-trauma patients who visited the ED during February–April 2019 were compared with those during February–April 2020. The number of visits, their dispositions, crowding parameters, and turnover rates were analyzed. The primary outcome was the change in ED attendance between the two periods. The secondary outcomes were changes in hospital admission rates, crowding parameters, and turnover rates. Results During the outbreak, there were decreased non-trauma ED visits by 33.45% (p < 0.001) and proportion of Taiwan Triage and Acuity Scale (TTAS) 3 patients (p=0.02), with increased admission rates by 4.7% (p < 0.001). Crowding parameters and turnover rate showed significant improvements. Conclusion Comparison of periods before and during the COVID-19 outbreak showed an obvious decline in adult, non-trauma ED visits. The reduction in TTAS 3 patient visits and the increased hospital admission rates provide references for future public-health policy-making to optimise emergency medical resource allocations globally.