No abstract

the dielectric permittivity far from the MIT κ 0 =10.7, the mean acceptor energy » E 42 0 meV and the mean density of the localized states » -( ) g 1.7 6.5 10 16 meV −1 cm −3 .

Introduction: Pre-hospital services are not well developed in Vietnam, especially the immature of a trauma system of care. The prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. This study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. Hypothesis: Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Methods: We performed a multicenter prospective observational study of consecutive patients (>16 years) presenting with traumatic OHCA to 3 central hospitals in Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients with traumatic OHCA and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. Results: Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 26.1% (29/111) of the patients were taken by the emergency medical services (EMS), 90% (27/30) received pre-hospital advanced airway, and 54.7% (29/53) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P>0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P=0.649; respectively). Conclusion: Improvements are needed in the EMS in Vietnam, such as increasing bystander first-aid and developing a trauma system of care, as well as developing a standard emergency first-aid program for both healthcare personnel and the community.

Introduction: Pre-hospital capabilities are minimally developed in Vietnam; therefore, the prognosis of OHCA might differ from that of other countries. The aim of this study was to investigate survival rate from OHCA and potential determinants of the chain of survival following an OHCA in a developing country. Hypothesis: Understanding the country-specific etiologies and the disease risk and prognosis of OHCA are crucial for reducing mortality in Vietnam, as well as in other countries that face challenges in clinical practice owing to limited medical resources. Methods: This is a multi-center prospective observational study of OHCA patients (age>18 years) presenting to the ED of three tertiary hospitals from February 2014 to December 2018. Factors associated with survival following OHCA were collected and compared among types of pre-hospital care transportation and between survival and non-survival to admission. Factors for survival to admission were assessed using logistic regression analysis. Results: Among 590 OHCA patients (male, 74.6%; age, 56.1±17.2 years), we observed low rates of survival to admission (24.2%) and discharge (14.1%). Of total patients, 67.8% occurred at home, 79.4% witnessed by bystanders, 124/555 (22.3%) received bystander CPR, a minority of patients (8.64%) was conveyed by EMS, and 49/152 (32.2%) received pre-hospital defibrillation. Multivariate analysis revealed that past medical history (PMH) of respiratory disease (OR, 3.128; 95% CI, 1.197-8.173), pre-hospital defibrillation (OR, 3.904; 95% CI, 1.540-9.898), pre-hospital advanced airway (OR, 3.441; 95% CI, 1.203-9.844) and ROSC at ED (OR, 2.891; 95% CI, 1.030-8.115) were independent factors for survival to admission. Following OHCA with cardiac etiology, EMS use (OR, 0.203; 95% CI, 0.044-0.935) was also an independent factor for survival to admission. Conclusions: This was a highly selected cohort of OHCA patients presenting to the ED. Many OHCA victims in Vietnam do not come to the ED. PMH of respiratory disease, pre-hospital defibrillation and advanced airway, and ROSC at ED were independent factors predicting survival to admission. EMS use was also an inverse and independent predictor of survival to admission among patients following OHCA with cardiac etiology.

Introduction: Bystander CPR is not often performed on OHCA patients, particularly in limited-resource regions. This study aimed to investigate the rate of OHCA patients who did not receive bystander CPR and its impact on the outcomes in an LMIC. Hypothesis: Understanding the reasons bystanders are reluctant to call EMS and how no bystander CPR impacts the outcomes of OHCA patients are crucial for improving survival in Vietnam. Methods: We performed a multicenter prospective cohort study of OHCA patients (≥18 years) presenting to three central hospitals in Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes and compared these data between patients who did not receive bystander CPR and patients who did. Using logistic regression, we assessed factors associated with survival and good neurological function on discharge (a CPC score of 1 or 2). Results: Of 521 patients, 388 (74.5%) were male, and the mean age was 56.71 years (SD: 17.32). Although most cardiac arrests (68.7%; 358/521) occurred at home and 67.9% (353/520) were witnessed by bystanders, a high rate (77.9%, 406/521) of these patients did not receive bystander CPR. Only half of the patients were taken by EMS (8.1%, 42/521) or private ambulance (42.8%, 223/521); 50.8% (133/262) of whom were given resuscitation attempts by EMS or private ambulance. There was no significant difference in survival to admission (16.7%; 68/406 and 24.3%; 28/115; p=0.064) and survival to discharge (7.9%; 32/406 and 14.8%; 17/115; p=0.094) between patients who did not receive bystander CPR and patients who did. In contrast, the rate of good neurological function of patients who did not receive bystander CPR (4.7%, 19/406) was significantly lower than that of patients who received bystander CPR (12.2%, 14/115; p=0.004). Moreover, multivariate analysis showed that no bystander CPR (OR: 0.276; 95% CI: 0.124-0.614) was inversely and independently associated with good neurological function. Conclusions: In our study, poor outcomes emphasize the need for increasing bystander CPR performance, increasing the number of EMS ambulances and the utilization of private ambulances, and developing a standard emergency first-aid program for both healthcare personnel and the community.