Association of transport time interval with neurologic outcome in out-of-hospital cardiac arrest patients without return of spontaneous circulation on scene and the interaction effect according to prehospital airway management

Abstract

Objective This study analyzed the association of transport time interval (TTI) with survival rate and neurologic outcome in out-of-hospital cardiac arrest (OHCA) patients without return of spontaneous circulation (ROSC) and the interaction effect of TTI according to prehospital airway management.Methods A retrospective observational study based on the nationwide OHCA database from January 2013 to December 2017 was designed. Emergency medical service (EMS)-treated OHCA patients aged ≥18 years were included. TTI was categorized into four groups of quartiles (≤4, 5–7, 8–11, ≥12 minutes). The primary outcome was favorable neurologic outcome at discharge. The secondary outcome was survival to discharge from the hospital. Multivariable logistic regression was used to analyze outcomes according to TTI. A different effect of TTI according to the administration of prehospital EMS advanced airway was evaluated.Results In total, 83,470 patients were analyzed. Good neurologic recovery decreased as TTI increased (1.0% for TTI ≤4 minutes, 0.9% for TTI 5–7 minutes, 0.6% for TTI 8–11 minutes, and 0.5% for TTI ≥12 minutes; P for trend <0.05). The adjusted odds ratio of prolonged TTI (≥12 minutes) was 0.73 (95% confidence interval, 0.57–0.93; P<0.01) for good neurologic recovery. However, the negative effect of prolonged TTI on neurological outcome was insignificant when advanced airway or entotracheal intubation were performed by EMS providers (adjusted odds ratio, 1.17; 95% confidence interval, 0.42–3.29; P=0.76).Conclusion EMS TTI was negatively associated with the neurologic outcome of OHCA without ROSC on scene. When advanced airway was performed on scene, TTI was insignificantly associated with the outcome.

The current trend of emergency airway management: a clinical review

“…The choice of an airway management strategy in cases of out-of-hospital cardiac arrest (OHCA) can be influenced by multiple factors, including the circumstances of the arrest, the patient's condition, the stage of resuscitation, the available equipment, and the skill level of the EMS clinician [102,103].…”

Copy-CAV: V2X-enabled wireless towing for emergency transport

“…where 𝑥 𝑖 is the spacing between the lead car and target tail vehicle taken at regular intervals, 𝑥 ideal is the desired spacing that should be maintained between the lead and tail vehicle, 𝑡 ideal is the empirical optimum emergency transport time [1] that provides for favorable outcomes and 𝑡 tow is the actual towing time. Additionally, the weights 𝑤 𝑡 and 𝑤 𝑥 are used to nudge the selection algorithm to choose options that perform better as regards towing time or spacing respectively.…”

“…For the present setup, we set 𝑥 ideal = 10 m, as proposed in [6], and 𝑡 ideal = 240 s as specified in [1]. Note that, for the second term of Eq.…”

“…The favorable outcome of a medical emergency largely depends on the timely delivery of professional or specialist care [1]. The latter is however complicated when the emergency occurs in inconvenient situations, such as while a person drives alone.…”

“…Compared to the vehicle-to-vehicle (V2V) communication paradigm, the vehicle-to-NR (V2N) approach solves uncoordinated channel access issues, 1 shadowing effects and limited communication range problems.…”