The number and level of first-contact emergency medical services crew and clinical outcomes in out-of-hospital cardiac arrest with dual dispatch response

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

doi:10.15441/ceem.22.205

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…In the case of cardiac arrest, two or more ambulances or fire engine close to the scene are dispatched, and dispatch-assisted CPR (DA-CPR) is provided at the same time. 22 23 EMS providers comprise emergency medical technicians (EMTs) or registered nurses, and the scope of practice is similar to that of EMT-intermediate in the United States. They perform basic life support and can attempt intravenous access, supraglottic airway (SGA), and endotracheal intubation (ETI) under direct medical direction.…”

Section: Methodsmentioning

confidence: 99%

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea

Kim¹,

Lee²,

Lim

et al. 2023

J Korean Med Sci

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Background Coronavirus disease 2019 (COVID-19) is a global public health crisis that has had a significant impact on emergency medical services (EMS). Several studies have reported an increase in the incidence of out-of-hospital cardiac arrest (OHCA) and a decreased survival due to COVID-19, which has been limited to a short period or has been reported in some regions. This study aimed to investigate the effect of COVID-19 on OHCA patients using a nationwide database. Methods We included adult OHCA patients treated by EMS providers from January 19, 2019 to January 20, 2021. The years before and after the first confirmed case in Korea were set as the non-COVID-19 and COVID-19 periods, respectively. The main exposure of interest was the COVID-19 period, and the primary outcome was prehospital return of spontaneous circulation (ROSC). Other OHCA variables were compared before and after the COVID-19 pandemic and analyzed. We performed a multivariable logistic regression analysis to understand the independent effect of the COVID-19 period on prehospital ROSC. Results The final analysis included 51,921 eligible patients, including 25,355 (48.8%) during the non-COVID-19 period and 26,566 (51.2%) during the COVID-19 period. Prehospital ROSC deteriorated during the COVID-19 period (10.2% vs. 11.1%, P = 0.001). In the main analysis, the adjusted odds ratios (AORs) for prehospital ROSC showed no significant differences between the COVID-19 and non-COVID-19 periods (AOR [95% confidence interval], 1.02 [0.96–1.09]). Conclusion This study found that the proportion of prehospital ROSC was lower during the COVID-19 period than during the non-COVID-19 period; however, there was no statistical significance when adjusting for potential confounders. Continuous efforts are needed to restore the broken chain of survival in the prehospital phase and increase the survival rate of OHCA patients.

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Section: Methodsmentioning

confidence: 99%

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea

Kim¹,

Lee²,

Lim

et al. 2023

J Korean Med Sci

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“…Declaration of death falls under the purview of hospital ED physicians. Ambulances with physician staff are not available, and advanced procedures, such as airway management, IV access, fluid and/or drug administration, and decisions regarding resuscitation withhold/withdrawal are directly overseen by medical directors, mainly emergency physicians [ 15 ]. EMS teams are typically comprised of 3 personnel (occasionally 2 personnel), with at least one EMT.…”

Section: Methodsmentioning

confidence: 99%

Impact of intravenous accessibility and prehospital epinephrine use on survival outcomes of adult nontraumatic out-of-hospital cardiac arrest patients

Park,

Choi,

Kim

2024

BMC Emerg Med

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Background This study compared out-of-hospital cardiac arrest (OHCA) patient outcomes based on intravenous (IV) access and prehospital epinephrine use. Methods A retrospective study in Ulsan, South Korea, from January 2017 to December 2022, analyzed adult nontraumatic OHCA cases. Patients were grouped: Group 1 (no IV attempts), Group 2 (failed IV access), Group 3 (successful IV access without epinephrine), and Group 4 (successful IV access with epinephrine), with comparisons using logistic regression analysis. Results Among 2,656 patients, Group 4 had significantly lower survival to hospital discharge (adjusted OR 0.520, 95% CI 0.346–0.782, p = 0.002) and favorable neurological outcomes (adjusted OR 0.292, 95% CI 0.140–0.611, p = 0.001) than Group 1. Groups 2 and 3 showed insignificant survival to hospital discharge (adjusted OR 0.814, 95% CI 0.566–1.171, p = 0.268) and (adjusted OR 1.069, 95% CI 0.810–1.412, p = 0.636) and favorable neurological outcomes (adjusted OR 0.585, 95% CI 0.299–1.144, p = 0.117) and (adjusted OR 1.075, 95% CI 0.689–1.677, p = 0.751). In the shockable rhythm group, Group 3 had better survival to hospital discharge (adjusted OR 1.700, 95% CI 1.044–2.770, p = 0.033). Conclusions Successful IV access with epinephrine showed worse outcomes in both rhythm groups than no IV attempts. Outcomes for failed IV and successful IV access without epinephrine were inconclusive. Importantly, successful IV access without epinephrine showed favorable survival to hospital discharge in the shockable rhythm group, warranting further research into IV access for fluid resuscitation in shockable rhythm OHCA patients.

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“…The EMS system in the region, which is government-based and single-tiered, provides basic to intermediate levels of EMS from fire agency headquarters. The EMS resuscitation protocol introduces multiple dispatches (two or more ambulance teams), provides on-site CPR, and transports patients to an ED in an ambulance with ongoing CPR 11 . EMS providers cannot stop CPR unless spontaneous circulation returns in the patient, either on-site or during transportation to the ED.…”

Section: Methodsmentioning

confidence: 99%

Modification of termination of resuscitation rule with compression time interval in South Korea

Park

Lim

Ryu

et al. 2023

Sci Rep

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This study aimed to validate the predictive performance of the termination of resuscitation (TOR) rule and examine the compression time interval (CTI) as a criterion for modifying the rule. This retrospective observational study analyzed adult out-of-hospital cardiac arrest (OHCA) patients attended by emergency medical service (EMS) providers in mixed urban–rural areas in Korea in 2020 and 2021. We evaluated the predictive performance of basic life support (BLS) and the Korean Cardiac Arrest Research Consortium (KoCARC) TOR rule using the false-positive rate (FPR) and positive predictive value (PPV). We modified the age cutoff criterion and examined the CTI as a new criterion. According to the TOR rule, 1827 OHCA patients were classified into two groups. The predictive performance of the BLS TOR rule had an FPR of 11.7% (95% confidence interval (CI): 5.9–17.5) and PPV of 98.4% (97.6–99.2) for mortality, and an FPR of 3.6% (0.0–7.8) and PPV of 78.6% (75.9–81.3) for poor neurological outcomes at hospital discharge. The predictive performance of the KoCARC TOR rule had an FPR of 5.0% (1.1–8.9) and PPV of 98.9% (98.0–99.8) for mortality, and an FPR of 3.7% (0.0–7.8) and PPV of 50.0% (45.7–54.3) for poor neurological outcomes at hospital discharge. The modified cutoff value for age was 68 years, with an area under the receiver operating characteristic curve over 0.7. In the group that met the BLS TOR rule, the cutoff of the CTI for death was not determined and was 21 min for poor neurological outcomes. In the group that met the KoCARC TOR rule, the cutoff of the CTI for death and poor neurological outcomes at the time of hospital discharge was 25 min and 21 min, respectively. The BLS TOR and KoCARC TOR rules showed inappropriate predictive performance for mortality and poor neurological outcomes. However, the predictive performance of the TOR rule could be supplemented by modifying the age criterion and adding the CTI criterion of the KoCARC.

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The number and level of first-contact emergency medical services crew and clinical outcomes in out-of-hospital cardiac arrest with dual dispatch response

Cited by 4 publications

References 33 publications

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Korea

Impact of intravenous accessibility and prehospital epinephrine use on survival outcomes of adult nontraumatic out-of-hospital cardiac arrest patients

Modification of termination of resuscitation rule with compression time interval in South Korea

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