Background During the coronavirus disease 2019 (COVID-19) pandemic, the format of patients with out-of-hospital cardiac arrest (OHCA) management was modified. Therefore, this study compared the response time and survival at the scene of patients with OHCA managed by emergency medical services (EMS) before and during the COVID-19 pandemic in Thailand. Methods This retrospective, observational study used EMS patient care reports to collect data on adult patients with OHCA coded with cardiac arrest. Before and during the COVID-19 pandemic was defined as the periods of January 1, 2018–December 31, 2019, and January 1, 2020–December 31, 2021, respectively. Results A total of 513 and 482 patients were treated for OHCA before and during the COVID-19 pandemic, respectively, showing a decrease of 6% (% change difference =− 6.0, 95% confidence interval [CI] − 4.1, − 8.5). However, the average number of patients treated per week did not differ (4.83 ± 2.49 vs. 4.65 ± 2.06; p value = 0.700). While the mean response times did not significantly differ (11.87 ± 6.31 vs. 12.21 ± 6.50 min; p value = 0.400), the mean on-scene and hospital arrival times were significantly higher during the COVID-19 pandemic compared with before by 6.32 min (95% CI 4.36–8.27; p value < 0.001), and 6.88 min (95% CI 4.55–9.22; p value < 0.001), respectively. Multivariable analysis revealed that patients with OHCA had a 2.27 times higher rate of return of spontaneous circulation (ROSC) (adjusted odds ratio = 2.27, 95% CI 1.50–3.42, p value < 0.001), and a 0.84 times lower mortality rate (adjusted odds ratio = 0.84, 95% CI: 0.58–1.22, p value = 0.362) during the COVID-19 pandemic period compared with that before the pandemic. Conclusions In the present study, there was no significant difference between the response time of patients with OHCA managed by EMS before and during COVID-19 pandemic period; however, markedly longer on-scene and hospital arrival times and higher ROSC rates were observed during the COVID-19 pandemic than those in the period before the pandemic.
Background Traffic accident patients place a tremendous burden on health care services because they require substantial, rapid, and effective evaluation, management, and treatment by emergency medical services (EMS) to decrease morbidity and mortality rates. This study investigated the 1-month survival rate and factors related to the survival of traffic accident patients managed by EMS. Patients and Methods We retrospectively analyzed data of traffic accident patients serviced by the Surgico Medical Ambulance and Rescue Team (SMART) at Vajira Hospital, Bangkok, from January 1, 2018, to December 31, 2020. The data were collected from EMS patient care reports recorded using the emergency medical triage protocol as well as the criteria-based dispatch response codes in Thailand. Survival data at 1 month were obtained from electronic medical records. Results Of the 340 traffic accident patients who fulfilled the study criteria, 314 (92.35%) were alive at 1 month. A multivariable analysis using multiple logistic regression identified prehospital level of consciousness, airway management, and cardiopulmonary resuscitation as factors associated with survival. Unresponsive patients had a lower survival rate than responsive patients (adjusted odds ratio [OR adj ] = 0.16, 95% confidence interval [CI]: 0.05–0.56, p = 0.004). Prehospital airway management and cardiopulmonary resuscitation reduced the survival rate by 0.30 and 0.10 times, respectively (OR adj = 0.30, 95% CI: 0.09–0.97, p = 0.045 and OR adj = 0.10, 95% CI: 0.02–0.47, p = 0.004, respectively). Conclusion Traffic accident patients had a high survival rate at 1 month. We identified three factors regarding EMS treatment which were related to increased survival: a prehospital responsive level of consciousness, no prehospital airway management, and no prehospital cardiopulmonary resuscitation. Therefore, the development of standard guidelines for the management of traffic accident patients by EMS is crucial to increase the survival rate of traffic accident patients.
Objective: To explore factors associated with successful on-scene cardiac resuscitation and to identify the number of patients with return of spontaneous circulation (ROSC). Materials and Methods: The present study was a retrospective descriptive study. Data were collected from the Surgico Medical Ambulance and Rescue Team at the Emergency Medicine Service and Disaster Division, Navamindradhiraj University. Data were recorded by using the overall operation reports of the Bangkok Emergency Medical Service Centre (Erawan Centre) about advanced life support. The reports used the code followed by the Emergency Medical Triage Protocol and Criteria Based Dispatch (CBD), CBD6 Red1, or followed by Response Code (RC) RC6 Red1, between May 2019 and April 2020. Results: Two hundred seventy-three patients with out-of-hospital cardiac arrest (OHCA) were included in the present study. Seventy (25.6%) patients were successfully on-scene resuscitated, of which, 65.7% were male patients with an average age of 57.87 (standard deviation [SD] 21.6) years. However, 203 (74.4%) patients that received appropriated advanced resuscitation (non-ROSC) died on scene. Among patients in the successful resuscitation group and those in the deceased group, 65.7% and 61.6% were male, respectively (p=0.537). The mean age was 57.87 (SD 21.6) years and 65.8 (SD 20.21) years, respectively (p=0.006). In the multivariate analysis controlled for confounders, a significant association (p<0.05) was found between successful pre-hospital cardiac resuscitation on scene with the following four factors, traumatic cardiac arrest (adjusted odds ratio [OR] 4.18, 95% confidence interval [CI] 1.60 to 10.93, p=0.004), response time within eight minutes (adjusted OR 2.07, 95% CI 1.03 to 4.14, p=0.041), initial electrocardiogram with ventricular fibrillation (adjusted OR 2.63, 95% CI 1.13 to 6.12, p=0.025, and pulseless electrical activity (adjusted OR 2.89, 95% CI 1.26 to 6.64, p=0.012), and administration of resuscitation drug with epinephrine (adjusted OR 13.62, 95% CI 4.72 to 39.31, p<0.001). Conclusion: In the present study, four factors were found to have a significant association with successful prehospital cardiac resuscitation on scene. Based on the knowledge discovered, these factors will develop on-scene CPR guidelines for the care of patients with OHCA for the authors’ emergency medical service personals. Keywords: Success; Resuscitation; Prehospital cardiac arrest
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