Location of arrest and effect of prehospital advanced airway management after emergency medical service-witnessed out-of-hospital cardiac arrest: nationwide observational study

Abstract

ObjectivesTo investigate the association of prehospital advanced airway management (AAM) on outcomes of emergency medical service (EMS)-witnessed out-of-hospital cardiac arrest (OHCA) according to the location of arrest.MethodsWe evaluated a Korean national OHCA database from 2012 to 2016. Adults with EMS-witnessed, non-traumatic OHCA were included. Patients were categorised into four groups according to whether prehospital AAM was conducted (yes/no) and location of arrest (‘at scene’ or ‘in the ambulance’). The primary outcome was discharge with good neurological recovery (cerebral performance category 1 or 2). Multivariable logistic regression analysis was conducted to evaluate the association between AAM and outcome according to the location of arrest.ResultsAmong 6620 cases, 1425 (21.5%) cases of arrest occurred ‘at the scene’, and 5195 (78.5%) cases of arrest occurred ‘in an ambulance’. Prehospital AAM was performed in 272 (19.1%) OHCAs occurring ‘at the scene’ and 645 (12.4%) OHCAs occurring ‘in an ambulance’. Patients with OHCA in the ambulance who had prehospital AAM showed the lowest good neurological recovery rate (6.0%) compared with OHCAs in the ambulance with no AAM (8.9%), OHCA at scene with AAM (10.7%) and OHCA at scene with no AAM (7.7%). For OHCAs occurring in the ambulance, the use of AAM had an adjusted OR of 0.67 (95% CI 0.45 to 0.98) for good neurological recovery.ConclusionOur data show no benefit of AAM in patients with EMS-witnessed OHCA. For patients with OHCA occurring in the ambulance, AAM was associated with worse clinical outcome.

Cross-Cultural Communication of Regional Images Based on Multimodal Discourse Analysis and Network Security

“…However, because the survey subjects are in a foreign cultural situation, it is extremely difficult to measure their attitudes and cognitions across geographic distances and cultural differences. Hence, this article combines cultural communication methods and modern location service technology to carry out regional image communication [11][12][13].…”