Factors Associated with Successful Resuscitation during Out-of-Hospital Cardiac Arrest Performed By Surgico Medical Ambulance and Rescue Team (S.M.A.R.T), Division of Emergency Medical Service and Disaster, Faculty of Medicine Vajira Hospital, Navamindrad

Abstract

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

The comparison of emergency medical service responses to and outcomes of out-of-hospital cardiac arrest before and during the COVID-19 pandemic in Thailand: a cross-sectional study

“…Thirdly, during the COVID-19 pandemic, patients with OHCA had a 2.27 times higher ROSC rate and a lower mortality rate than those before the COVID-19. The increased ROSC rate seen in the present study may have from the EMS team being confident when encountering patients with COVID-19 due to PPE use, as well as other important factors affecting the ROSC of patients with OHCA at the scene [ 4 ], including witnessed arrest (88.4% during COVID-19 pandemic vs. 44.1% before it), bystander CPR (67.8% during COVID-19 pandemic vs. 34.3% before it), and advanced airway management included endotracheal intubation (51.9% during COVID-19 pandemic vs. 46.0% before it). During the period, EMS teams encountered patients with OHCA with preparation, defense, and adaptation in response to the situation to improve the patients’ survival, so that even though this was the area most impacted by the COVID-19 pandemic situation in Bangkok, Thailand, the quality and service for patients with OHCA was not compromised.…”

“…This retrospective observational study utilized data collected by the Surgico Medical Ambulance and Rescue Team (S.M.A.R.T), Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, dispatched by Erawan Center, Bangkok, which has six network hospitals, responsible for the care of 500,000 people within 50 square kilometers [ 4 ].The first patient in the study area was confirmed on January 13th, 2020, by the Ministry of Public Health. During the study period, 437,303 patients were confirmed as having COVID-19 in the study area, making it the most densely populated COVID-19 area [ 19 ].…”

“…In Thailand, the incidence of OHCA averages 6,450 cases per year. More than 65.7% of the patients with OHCA who are successfully resuscitated at the scene by emergency medical service (EMS) survived at the scene [ 4 ]; however, their survival rate to admission and discharge is only 27.7% and 4.2%, respectively. For the most common cause of OHCA, more than half was presumed cardiac etiology [ 5 ].…”