Association between prehospital prognostic factors and out-of-hospital cardiac arrest: Effect of rural–urban disparities

Hsu, Ying-Chen; Wu, Woei-Cherng; Huang, Jyun-Bin; Lee, Kuo-Hsin; Cheng, Fu-Jen

doi:10.1016/j.ajem.2020.10.054

“…In this study, we analyzed the different prognostic factors for OHCA for different age groups. Compared with the age group 2 (age > 75 years), we found that bystander CPR and prehospital defibrillation by AED were [3,17,20], location of OHCA [3,13], EMS response time [15,21], attended by EMT-Paramedic [22], and witness of OHCA [23]. Old age might be a poor prognostic factor for OCA.…”

Section: Discussionmentioning

confidence: 74%

Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups

Huang

¹

,

Lee

²

,

Ho

³

et al. 2021

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Background The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor. While several prehospital factors are known to be associated with improved survival, the impact of prehospital factors on different age groups is unclear. The objective of the study was to access the impact of prehospital factors and pre-existing comorbidities on OHCA outcomes in different age groups. Methods A retrospective observational analysis was conducted using the emergency medical service (EMS) database from January 2015 to December 2019. We collected information on prehospital factors, underlying diseases, and outcome of OHCAs in different age groups. Kaplan-Meier type survival curves and multivariable logistic regression were used to analyze the association between modifiable pre-hospital factors and outcomes. Results A total of 4188 witnessed adult OHCAs were analyzed. For the age group 1 (age ≦75 years old), after adjustment for confounding factors, EMS response time (odds ratio [OR] = 0.860, 95% confidence interval [CI]: 0.811–0.909, p < 0.001), public location (OR = 1.843, 95% CI: 1.179–1.761, p < 0.001), bystander CPR (OR = 1.329, 95% CI: 1.007–1.750, p = 0.045), attendance by an EMT-Paramedic (OR = 1.666, 95% CI: 1.277–2.168, p < 0.001), and prehospital defibrillation by automated external defibrillator (AED)(OR = 1.666, 95% CI: 1.277–2.168, p < 0.001) were prognostic factors for survival to hospital discharge in OHCA patients. For the age group 2 (age > 75 years old), age (OR = 0.924, CI:0.880–0.966, p = 0.001), EMS response time (OR = 0.833, 95% CI: 0.742–0.928, p = 0.001), public location (OR = 4.290, 95% CI: 2.450–7.343, p < 0.001), and attendance by an EMT-Paramedic (OR = 2.702, 95% CI: 1.704–4.279, p < 0.001) were independent prognostic factors for survival to hospital discharge in OHCA patients. Conclusions There were variations between younger and older OHCA patients. We found that bystander CPR and prehospital defibrillation by AED were independent prognostic factors for younger OHCA patients but not for the older group.

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“…The total training program time to qualify for EMT-I, EMT-II, and EMT-P roles was 40 h, 280 h, and 1280 h, respectively. All EMS agents can perform BLS, LMA insertion, and defibrillation, but only EMT-P agents are authorized to perform advanced life support (ALS) procedures, including intubation, insertion of intravenous lines, and administration of certain medications, such as epinephrine and amiodarone [ 2 ]. Ono et al reported that 29.8% to 33.6% of OHCA patients received an intravenous line; in our study, only 27.0% of the OHCA patients were treated by an EMT-P.…”

Section: Discussionmentioning

confidence: 99%

“…The EMS data of OHCA patients were collected from January 2015 to December 2019. The EMS database has been described previously [ 2 ]. Briefly, EMS is a single-tiered fire department-based system, maintained by the Taiwanese government, and the data are stored electronically in every province's EMS command center.…”

Section: Methodsmentioning

confidence: 99%

“…Out-of-hospital cardiac arrest (OHCA) is defined as the termination of cardiac mechanical activity and subsequent cessation of blood circulation in a patient outside of a hospital [ 1 ]. Despite improvements in prehospital management and the use of automated external defibrillators (AEDs), only 10%–20% of the patients who experience OHCA survive to hospital discharge [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The emergency medical service (EMS) response time is defined as the time interval between the call made to the EMS and the arrival of the EMS team at the scene. EMS response time is a key prognostic factor for OHCA, and many studies have shown that short EMS response time is associated with a high probability of survival to hospital discharge and favorable neurologic outcomes [ 2 , 7 , 8 ]. On the other hand, patient-level characteristics, such as sex, age, and comorbidities, might also be prognostic factors of OHCA [ 9 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Response Time Threshold for Predicting Outcomes of Patients with Out-of-Hospital Cardiac Arrest

Huang

¹

,

Ho

²

,

Tsai

³

et al. 2021

Emergency Medicine International

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Ambulance response time is a prognostic factor for out-of-hospital cardiac arrest (OHCA), but the impact of ambulance response time under different situations remains unclear. We evaluated the threshold of ambulance response time for predicting survival to hospital discharge for patients with OHCA. A retrospective observational analysis was conducted using the emergency medical service (EMS) database (January 2015 to December 2019). Prehospital factors, underlying diseases, and OHCA outcomes were assessed. Receiver operating characteristic (ROC) curve analysis with Youden Index was performed to calculate optimal cut-off values for ambulance response time that predicted survival to hospital discharge. In all, 6742 cases of adult OHCA were analyzed. After adjustment for confounding factors, age (odds ratio [OR] = 0.983, 95% confidence interval [CI]: 0.975–0.992, p < 0.001 ), witness (OR = 3.022, 95% CI: 2.014–4.534, p < 0.001 ), public location (OR = 2.797, 95% CI: 2.062–3.793, p < 0.001 ), bystander cardiopulmonary resuscitation (CPR, OR = 1.363, 95% CI: 1.009–1.841, p = 0.044 ), EMT-paramedic response (EMT-P, OR = 1.713, 95% CI: 1.282–2.290, p < 0.001 ), and prehospital defibrillation using an automated external defibrillator ([AED] OR = 3.984, 95% CI: 2.920–5.435, p < 0.001 ) were statistically and significantly associated with survival to hospital discharge. The cut-off value was 6.2 min. If the location of OHCA was a public place or bystander CPR was provided, the threshold was prolonged to 7.2 min and 6.3 min, respectively. In the absence of a witness, EMT-P, or AED, the threshold was reduced to 4.2, 5, and 5 min, respectively. The adjusted OR of EMS response time for survival to hospital discharge was 1.217 (per minute shorter, CI: 1.140–1299, p < 0.001 ) and 1.992 (<6.2 min, 95% CI: 1.496–2.653, p < 0.001 ). The optimal response time threshold for survival to hospital discharge was 6.2 min. In the case of OHCA in public areas or with bystander CPR, the threshold was prolonged, and without witness, the optimal response time threshold was shortened.

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How do current police practices impact trauma care in the prehospital setting? A scoping review

Salhi

¹

,

Iyengar

²

,

Bhatia

³

et al. 2023

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Objective: In the United States, police are often important co-responders to 911 calls with emergency medical services for medical emergencies. To date, there remains a lack of a comprehensive understanding of the mechanisms by which police response modifies time to in-hospital medical care for traumatically injured patients. Further, it remains unclear if differentials exist within or between communities. A scoping review was performed to identify studies evaluating prehospital transport of traumatically injured patients and the role or impact of police involvement.Methods: PubMed, SCOPUS, and Criminal Justice Abstracts databases were utilized to identify articles. English-language, US-based, peer-reviewed articles published on or prior to March 30, 2022 were eligible for inclusion.Results: Of 19,437 articles initially identified, 70 articles were selected for full review and 17 for final inclusion. Key findings included (1) current law enforcement practices involving scene clearance introduce the potential for delayed patient transport but to date there is little research quantifying delays; (2) police transport protocols may decrease transport times; and (3) there are no studies examining the potential impact of scene clearance practices at the patient or community level. Conclusions:Our results highlight that police are often the first on scene when responding to traumatic injuries and have an active role via scene clearance or, in some systems, patient transport. Despite the significant potential for impact on patient well-being, there remains a paucity of data examining and driving current practices.

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Association between prehospital prognostic factors and out-of-hospital cardiac arrest: Effect of rural–urban disparities

Cited by 15 publications

References 34 publications

Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups

Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups

Response Time Threshold for Predicting Outcomes of Patients with Out-of-Hospital Cardiac Arrest

How do current police practices impact trauma care in the prehospital setting? A scoping review

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