Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries

Lin, Chih Hao; Ng, Yih Yng; Chiang, Wen-Chu; Karim, Sarah Abdul; Shin, Sang Do; Tanaka, Hideharu; Nishiuchi, Tatsuya; Kajino, Kentaro; Khunkhlai, Nalinas; Ming, Matthew Huei; Ong, Marcus Eng Hock

doi:10.1016/j.jfma.2015.10.003

Cited by 31 publications

(32 citation statements)

References 32 publications

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“…Furthermore, ambulance services in our region exhibited comparable guidelines around resuscitation efforts, all of which have an emphasis on attempting to achieve ROSC at the scene. This is in contrast to ambulance services in PAROS in which all services transported patients with CPR after a short (2–4 min) period of resuscitation at the scene . We also observed large variations in the number of events and OHCA cases attended by ambulance services in our region, and this is reflective of both the population served and geographical area covered by these ambulance services.…”

Section: Discussionmentioning

confidence: 57%

“…All services reported that they followed the 2010 (now 2015) ANZCOR resuscitation guidelines, which are co-badged by both the Australian Resuscitation Council (ARC) and the New Zealand Resuscitation Council (NZRC). 20,21 Two services noted minor modifications to the ANZCOR guidelines; one indicated that a second dose of amiodarone (150 mg) can be provided in lengthy arrests (SAAS), whereas another noted that only BLS is to be provided in the first 6 min of resuscitation (QAS). AV and SJANT were the only ambulance services who conduct a period of CPR prior to rhythm analysis (Table 6), and this time period was defined as 2 min (AV) or 2-3 min (SJANT).…”

Section: Treatmentmentioning

confidence: 99%

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Description of the ambulance services participating in the Aus‐ROC Australian and New Zealand out‐of‐hospital cardiac arrest Epistry

Beck

Bray

Smith

et al. 2016

Emerg Medicine Australasia

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Section: Discussionmentioning

confidence: 57%

Section: Treatmentmentioning

confidence: 99%

Description of the ambulance services participating in the Aus‐ROC Australian and New Zealand out‐of‐hospital cardiac arrest Epistry

Beck

Bray

Smith

et al. 2016

Emerg Medicine Australasia

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“…This may be due to a heterogenous population resulting in a more complex multilingual environment, further complicated by a population with relatively lower health literacy as large swathes of Asia are still developing [25]. Moreover, differences in dispatch algorithms, instructions and protocols also exist [26], and DACPR remains a fairly recent introduction within the network.…”

Section: Discussionmentioning

confidence: 99%

Emergency medical dispatch services across Pan-Asian countries: a web-based survey

Lee

Mao

et al. 2020

BMC Emerg Med

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Background: Dispatch services (DS's) form an integral part of emergency medical service (EMS) systems. The role of a dispatcher has also evolved into a crucial link in patient care delivery, particularly in dispatcher assisted cardiopulmonary resuscitation (DACPR) during out-of-hospital cardiac arrest (OHCA). Yet, there has been a paucity of research into the emerging area of dispatch science in Asia. This paper compares the characteristics of DS's, and state of implementation of DACPR within the Pan-Asian Resuscitation Outcomes (PAROS) network. Methods: A cross-sectional descriptive survey addressing population characteristics, DS structures and levels of service, state of DACPR implementation (including protocols and quality improvement programs) among PAROS DS's. Results: 9 DS's responded, representing a total of 23 dispatch centres from 9 countries that serve over 80 million people. Most PAROS DS's operate a tiered dispatch response, have implemented medical oversight, and tend to be staffed by dispatchers with a predominantly medical background. Almost all PAROS DS's have begun tracking key EMS indicators. 77.8% (n = 7) of PAROS DS's have introduced DACPR. Of the DS's that have rolled out DACPR, 71.4% (n = 5) provided instructions in over one language. All DS's that implemented DACPR and provided feedback to dispatchers offered feedback on missed OHCA recognition. The majority of DS's (83.3%; n = 5) that offered DACPR and provided feedback to dispatchers also implemented corrective feedback, while 66.7% (n = 4) offered positive feedback. Compression-only CPR was the standard instruction for PAROS DS's. OHCA recognition sensitivity varied widely in PAROS DS's, ranging from 32.6% (95% CI: 29.9-35.5%) to 79.2% (95% CI: 72.9-84.4%). Median time to first compression ranged from 120 s to 220 s. Conclusions: We found notable variations in characteristics and state of DACPR implementation between PAROS DS's. These findings will lay the groundwork for future DS and DACPR studies in the PAROS network.

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“…Asian regions often apply a scoop-andrun strategy, with short in-field CPR-duration (2À4 min. in most Asian regions a recent study), 46 and possibly earlier application of the TORrules. Previous Asian studies indeed showed that specificity decreased with decreasing time to TOR-rule application.…”

Section: Diagnostic Performancementioning

confidence: 94%

Diagnostic performance of the basic and advanced life support termination of resuscitation rules: A systematic review and diagnostic meta-analysis

et al. 2020

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Aim: To minimize termination of resuscitation (TOR) in potential survivors, the desired positive predictive value (PPV) for mortality and specificity of universal TOR-rules are !99%. In lack of a quantitative summary of the collective evidence, we performed a diagnostic meta-analysis to provide an overall estimate of the performance of the basic and advanced life support (BLS and ALS) termination rules. Data sources:We searched PubMed/EMBASE/Web-of-Science/CINAHL and Cochrane (until September 2019) for studies on either or both TORrules in non-traumatic, adult cardiac arrest. PRISMA-DTA-guidelines were followed.Results: There were 19 studies: 16 reported on the BLS-rule (205.073 patients, TOR-advice in 57%), 11 on the ALS-rule (161.850 patients, TOR-advice in 24%). Pooled specificities were 0.95 (0.89À0.98) and 0.98 (0.95À1.00) respectively, with a PPV of 0.99 (0.99À1.00) and 1.00 (0.99À1.00).Specificities were significantly lower in non-Western than Western regions: 0.84 (0.73À0.92) vs. 0.99 (0.97À0.99), p < 0.001 for the BLS rule. For the ALS-rule, specificities were 0.94 (0.87À0.97) vs. 1.00 (0.99À1.00), p < 0.001. For non-Western regions, 16 (BLS) or 6 (ALS) out of 100 potential survivors met the TOR-criteria. Meta-regression demonstrated decreasing performance in settings with lower rates of in-field shocks.Conclusions: Despite an overall high PPV, this meta-analysis highlights a clinically important variation in diagnostic performance of the BLS and ALS TOR-rules. Lower specificity and PPV were seen in non-Western regions, and populations with lower rates of in-field defibrillation. Improved insight in the varying diagnostic performance is highly needed, and local validation of the rules is warranted to prevent in-field termination of potential survivors.

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Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries

Cited by 31 publications

References 32 publications

Description of the ambulance services participating in the Aus‐ROC Australian and New Zealand out‐of‐hospital cardiac arrest Epistry

Description of the ambulance services participating in the Aus‐ROC Australian and New Zealand out‐of‐hospital cardiac arrest Epistry

Emergency medical dispatch services across Pan-Asian countries: a web-based survey

Diagnostic performance of the basic and advanced life support termination of resuscitation rules: A systematic review and diagnostic meta-analysis

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