The effect of the number and level of emergency medical technicians on patient outcomes following out of hospital cardiac arrest in Taipei

Sun, Jen Tang; Chiang, Wen-Chu; Hsieh, Ming‐Ju; Huang, Edward Pei-Chuan; Yang, Wen-Shuo; Chien, Yu-Chun; Wang, Yao Cheng; Lee, Bin Chou; Sim, Shyh Shyong; Tsai, Kuang Chao; Huei‐Ming, Matthew; Chen, Lee Wei

doi:10.1016/j.resuscitation.2017.11.048

Cited by 39 publications

(36 citation statements)

References 23 publications

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“…Traditional CPR for patients who experienced OHCA and IHCA was associated with low hospital survival rates, namely 7.2–9.9% [10, 31, 32] and 14.2–15.7% [33, 34], respectively. Notably, most of the patients achieving return of spontaneous circulation (ROSC) were resuscitated for < 30 min (42.5%), whereas only 6% of patients achieving ROSC were resuscitated for > 30 min [33].…”

Section: Discussionmentioning

confidence: 99%

“…This indicates that clinical discretion during CPR consultation favors young patients for ECMO support. In addition to age, patients with low CCI scores (J Clin Med 7(10):313; https://doi.org/10.3390/jcm7100313 (2018) (registering DOI) ) who had received short-duration cardiac massages, high-quality CPR from EMTs [31], or ACS in etiology (according to initial assessments) had relatively high chances of receiving ECMO during CPR as a temporary cardiopulmonary support for the definite diagnosis and treatment and later recovery of cardiopulmonary and neurologic functions.…”

Section: Discussionmentioning

confidence: 99%

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Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation

Wang

Chi

et al. 2018

Intensive Care Med

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PurposeCaseloads of extracorporeal cardiopulmonary resuscitation (ECPR) have increased considerably, and hospital mortality rates remain high and unpredictable. The present study evaluated the effects of the interplay between age and prolonged low-flow duration (LFD) on hospital survival rates in elderly patients to identify subgroups that can benefit from ECPR.MethodsAdult patients who received ECPR in our institution (2006–2016) were classified into groups 1, 2, and 3 (18–65, 65–75, and > 75 years, respectively). Data regarding ECPR and adverse events during hospitalization were collected prospectively. The primary end point was favorable neurologic outcome (cerebral performance category 1 or 2) at hospital discharge.ResultsIn total, 482 patients were divided into groups 1, 2, and 3 (70.5%, 19.3%, and 10.2%, respectively). LFDs were comparable among the groups (40.3, 41.0, and 44.3 min in groups 1, 2, and 3, P = 0.781, 0.231, and 0.382, respectively). Favorable neurologic outcome rates were nonsignificantly lower in group 3 than in the other groups (27.6%, 24.7%, and 18.4% for group 1, 2, and 3, respectively). Subgroup analysis revealed that the favorable neurologic outcome rates in group 1 were 36.7%, 25.4%, and 13.0% for LFDs of < 30, 30–60, and > 60 min, respectively (P = 0.005); in group 2, they were 32.1%, 21.2%, and 23.1%, respectively (P = 0.548); in group 3 they were 25.0%, 20.8%, and 0.0%, respectively (P = 0.274).ConclusionOn emergency consultation for ECPR, age and low-flow duration should be considered together to predict neurologic outcome.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5496-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation

Wang

Chi

et al. 2018

Intensive Care Med

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“…The number and proportion of EMTs on the scene for OHCA resuscitation has remained a modifiable factor linked to ROSC [13][14][15][16][17]. Until now, the influences of the EMT configuration on outcomes of OHCA patients remain controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Since the level of EMTs differs in the resuscitation they can provide, the number and level of EMTs in the field are considered crucial determinants for the outcomes of OHCA patients. However, the impact of the EMT configuration on patient survival remains debated [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest

Fang

Lin

et al. 2020

IJERPH

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Paramedics can provide advanced life support (ALS) for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of emergency medical technician (EMT) configuration on their outcomes remains debated. A three-year cohort study consisted of non-traumatic OHCA adults transported by ALS teams was retrospectively conducted in Tainan City using an Utstein-style population database. The EMT-paramedic (EMT-P) ratio was defined as the EMT-P proportion out of all on-scene EMTs. Among the 1357 eligible cases, the median (interquartile range) number of on-scene EMTs and the EMT-P ratio were 2 (2–2) persons and 50% (50–100%), respectively. The multivariate analysis identified five independent predictors of sustained return of spontaneous circulation (ROSC): younger adults, witnessed cardiac arrest, prehospital ROSC, prehospital defibrillation, and comorbid diabetes mellitus. After adjustment, every 10% increase in the EMT-P ratio was on average associated with an 8% increased chance (adjusted odds ratio [aOR], 1.08; p < 0.01) of sustained ROSC and a 12% increase change (aOR, 1.12; p = 0.048) of favorable neurologic status at discharge. However, increased number of on-scene EMTs was not linked to better outcomes. For nontraumatic OHCA adults, an increase in the on-scene EMT-P ratio resulted in a higher proportion of improved patient outcomes.

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Effect of implementation of multi-tier response system and prolonged on-scene resuscitation for out-of-hospital cardiac arrest

Jung

Ryu

et al. 2022

The American Journal of Emergency Medicine

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The effect of the number and level of emergency medical technicians on patient outcomes following out of hospital cardiac arrest in Taipei

Cited by 39 publications

References 23 publications

Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation

Effect of interplay between age and low-flow duration on neurologic outcomes of extracorporeal cardiopulmonary resuscitation

Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest

Effect of implementation of multi-tier response system and prolonged on-scene resuscitation for out-of-hospital cardiac arrest

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