Does second EMS unit response time affect outcomes of OHCA in multi-tiered system? A nationwide observational study

Park, Jeong Ho; Song, Kyoung Jun; Shin, Sang Do; Hong, Ki Jeong

doi:10.1016/j.ajem.2020.02.018

Cited by 10 publications

(11 citation statements)

References 28 publications

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“…As seen in Figure 1 , a total of eight studies were included in this systematic review ref. [ 12 , 13 , 14 , 15 , 16 , 20 , 21 , 22 ]. Most of these were retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

“…In a South Korean study of MTRs [ 20 ], an early MTR (defined as 0–18 min from call to second EMS arrival) was essential to improve neurological outcomes and survival-to-discharge compared to the single-tiered response group or late MTR group (19 min or longer from call to second EMS arrival). In fact, a late MTR had slightly better prehospital ROSC rates than the single-tiered response system but worse survival and neurological outcomes.…”

Section: Discussionmentioning

confidence: 99%

“… Forest plot showing pooled OR for survival-to-discharge with HP CPR or similar intervention compared to controls [ 12 , 14 , 16 , 20 , 21 , 22 ]. …”

Section: Figurementioning

confidence: 99%

See 2 more Smart Citations

A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes

Han

Lim

et al. 2021

JCM

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Despite numerous technological and medical advances, out-of-hospital cardiac arrests (OHCAs) still suffer from suboptimal survival rates and poor subsequent neurological and functional outcomes amongst survivors. Multiple studies have investigated the implementation of high-quality prehospital resuscitative efforts, and across these studies, different terms describing high-quality resuscitative efforts have been used, such as high-performance CPR (HP CPR), multi-tiered response (MTR) and minimally interrupted cardiac resuscitation (MICR). There is no universal definition for HP CPR, and dissimilar designs have been employed. This systematic review thus aimed to review current evidence on HP CPR implementation and examine the factors that may influence OHCA outcomes. Eight studies were systematically reviewed, and seven were included in the final meta-analysis. Random-effects meta-analysis found a significantly improved likelihood of prehospital return of spontaneous circulation (pooled odds ratio (OR) = 1.46, 95% CI: 1.16 to 1.82, p < 0.001), survival-to-discharge (pooled OR = 1.32, 95% CI: 1.16 to 1.50, p < 0.001) and favourable neurological outcomes (pooled OR = 1.24, 95% CI: 1.11 to 1.39, p < 0.001) with HP CPR or similar interventions. However, the studies had generally high heterogeneity (I2 greater than 50%) and overall moderate-to-severe risk for bias. Moving forward, a randomised, controlled trial is necessary to shed light on the subject.

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“…As seen in Figure 1 , a total of eight studies were included in this systematic review ref. [ 12 , 13 , 14 , 15 , 16 , 20 , 21 , 22 ]. Most of these were retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes

Han

Lim

et al. 2021

JCM

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“…The time from onset to PCI is approximately 290 min, and only 7% of patients receive timely PCI therapy, contributing to increased mortality from cardiovascular disease, which is the leading cause of death in China [ 2 ]. The times from call-to-emergency medical services (EMS) to the scene and the door-to-balloon time are about 21 and 94 min respectively, which is longer than the average time of 7 and 59 min in some developed countries [ 3 , 4 ]. Clinical studies have shown that for every 30 min that treatment is delayed, the one-year mortality rate after STEMI increases by 7.5% [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis

Dong

Jin

et al. 2021

IJERPH

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Reducing the treatment delay by organizing delivery of care on a regional basis is a priority for improving the quality of ST-segment elevated myocardial infarction (STEMI) care. This study aimed to evaluate the impact of the combined measures on quality metrics of healthcare delivery in Suzhou. The data were collected from the National Chest Pain Center (CPC) Data Reporting Database. 4775 patients were recruited, and after propensity-score matching, 1078 pairs were finally included for analysis. We examined the changes in quality metrics of care including prehospital and in-hospital processes, and clinic outcomes. Quality improvement (QI) implementation improved most process indicators. However, these improvements did not yield decreased in-hospital mortality. The door-to-balloon and the FMC-to-device time decreased from 85.0 and 98.0 min to 78 and 88 min, respectively (p < 0.001). Cases transferred directly via EMS had a greater improvement in most of process indicators. The proportion of patients transferred directly via EMS was 10.3%, much lower than that of self-transported patients at 58.3%. Tertiary hospitals showed greater performance improvement in process indicators than secondary hospitals. The percentage of cases using EMS remained low for suburban areas. The establishment of coordinated STEMI care needs to be accompanied with solving the fragmented situation of the prehospital and hospital care, and patient delay should be addressed, especially in suburban areas and on transferred-in inpatients.

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“…El personal lego (no profesionales de la salud) desem peña un papel im portante en la reanimación cardiopulm onar (RCP). Las acciones iniciales incluyen el reconocimiento del evento, la activación del sistema de emergencias médicas (SEM), el pronto inicio de manio bras de RCP y el uso de un desfibrilador externo auto mático (DEA) (16). Es im portante tener presente q ue la tasa de so brevida disminuye entre 10 % y 15 % por cada minuto en el q ue un paciente se encuentre en PCR y el desarrollo de daño neurológico se incrementa en igual proporción (17).…”

Section: Introductionunclassified

Paro cardiaco extrahospitalario: conocimientos en una comunidad universitaria

Avila

2021

Rev. Colomb. Enferm.

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OBJETIVO: determinar el nivel de conocimiento de una comunidad universitaria en Bogotá, para actuar como primer respondiente ante situaciones de emergencia como el paro cardiorrespiratorio y sus principales causas. METODOLOGÍA: estudio cuantitativo, descriptivo y transversal. Muestra, 1.294 integrantes de una comunidad universitaria, margen de error 3%, nivel de confianza 97%. Muestreo por conveniencia. La información se recolectó a través de la plataforma Google forms ®, por medio de un cuestionario de 14 preguntas, distribuidas en tres categorías, reconocimiento del evento, activación de sistema de emergencias y atenciòn inicial. Se cumplieron los requisitos éticos para la investigación en salud en Colombia. RESULTADOS: el 62.7% de los participantes identifica las acciones para reconocer un paro cardio respiratorio y aunque el 83,6% ante estas situaciones llamaría a emergencias solo el 37% conoce el número telefónico. La sospecha de síndrome coronario agudo es un evento considerado por un 68,2% como una emergencia, no sucede lo mismo con el ACV, donde solo el 52,1%, tiene esta claridad. El 81.4% describe acciones correctas frente a una víctima con obstrucción grave de la vía aérea por cuerpo extraño, 50.6% si la obstrucción es leve. CONCLUSIÓN: el nivel de conocimiento de la comunidad universitaria en materia de atención del paro cardiorrespiratorio extrahospitalario es bajo predominantemente relacionado con las maniobras de reanimación cardiopulmonar y la operación del DEA. Resulta necesario implementar estrategias educativas dirigidas a todas las comunidades y esto podría ser una oportunidad de desarrollo para el profesional de enfermería en los diferentes ámbitos de acción.

show abstract

Does second EMS unit response time affect outcomes of OHCA in multi-tiered system? A nationwide observational study

Cited by 10 publications

References 28 publications

A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes

A Systematic Review and Meta-Analysis of the Implementation of High-Performance Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcomes

Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis

Paro cardiaco extrahospitalario: conocimientos en una comunidad universitaria

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