Search

Extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) is increasing. There is little evidence identifying the association between hospital ECLS case volumes and outcomes in different populations receiving ECLS or conventional cardiopulmonary resuscitation (CPR). The goal of this investigation was to identify the association between ECLS case volumes and clinical outcomes of OHCA patients. This cross-sectional observational study used the National OHCA Registry for adult OHCA cases in Seoul, Korea between January 2015 and December 2019. If the ECLS volume during the study period was >20, the institution was defined as a high-volume ECLS center. Others were defined as low-volume ECLS centers. Outcomes were good neurologic recovery (cerebral performance category 1 or 2) and survival to discharge. We performed multivariate logistic regression and interaction analyses to assess the association between case volume and clinical outcome. Of the 17,248 OHCA cases, 3,731 were transported to high-volume centers. Among the patients who underwent ECLS, those at high-volume centers had a higher neurologic recovery rate than those at low-volume centers (17.0% vs. 12.0%), and the adjusted OR for good neurologic recovery was 2.22 (95% confidence interval (CI): 1.15–4.28) in high-volume centers compared to low-volume centers. For patients who received conventional CPR, high-volume centers also showed higher survival-to-discharge rates (adjusted OR of 1.16, 95%CI: 1.01–1.34). High-volume ECLS centers showed better neurological recovery in patients who underwent ECLS. High-volume centers also had better survival-to-discharge rates than low-volume centers for patients not receiving ECLS. [ABSTRACT FROM AUTHOR]

Asia is experiencing a demographic shift toward an aging population at an unrivaled rate. This can influence the characteristics and outcomes of trauma. We aim to examine different characteristics of older adult trauma patients compared to younger adult trauma patients and describe factors that affect the outcomes in Asian countries. This is a retrospective, international, multicenter study of trauma across participating centers in the Pan Asian Trauma Outcome Study (PATOS) registry, which included trauma cases aged ≥18 years, brought to the emergency department (ED) by emergency medical services (EMS) from October 2015 to November 2018. Data of older adults (≥65 years) and younger adults (<65 years) were analyzed and compared. The primary outcome measure was in-hospital mortality, and secondary outcomes were disability at discharge and hospital and intensive care unit (ICU) length of stays. Of 39,804 trauma patients, 10,770 (27.1%) were older adults. Trauma occurred more among older adult women (54.7% vs 33.2%, p < 0.001). Falls were more frequent in older adults (66.3% vs 24.9%, p < 0.001) who also had higher mean Injury Severity Score (ISS) compared to the younger adult trauma patient (5.4 ± 6.78 vs 4.76 ± 8.60, p < 0.001). Older adult trauma patients had a greater incidence of poor Glasgow Outcome Scale (GOS) (13.4% vs 4.1%, p < 0.001), higher hospital mortality (1.5% vs 0.9%, p < 0.001) and longer median hospital length of stay (12.8 vs 9.8, p < 0.001). Multiple logistic regression revealed age (adjusted odds ratio [AOR] 1.06, 95%CI 1.02–1.04, p < 0.001), male sex (AOR 1.60, 95%CI 1.04–2.46, p = 0.032), head and face injuries (AOR 3.25, 95%CI 2.06–5.11, p < 0.001), abdominal and pelvic injuries (AOR 2.78, 95%CI 1.48–5.23, p = 0.002), cardiovascular (AOR 2.71, 95%CI 1.40–5.22, p = 0.003), pulmonary (AOR 3.13, 95%CI 1.30–7.53, p = 0.011) and cancer (AOR 2.03, 95%CI 1.02–4.06, p = 0.045) comorbidities, severe ISS (AOR 2.06, 95%CI 1.23–3.45, p = 0.006), and Glasgow Coma Scale (GCS) ≤8 (AOR 12.50, 95%CI 6.95–22.48, p < 0.001) were significant predictors of hospital mortality. Older trauma patients in the Asian region have a higher mortality rate than their younger counterparts, with many significant predictors. These findings illustrate the different characteristics of older trauma patients and their potential to influence the outcome. Preventive measures for elderly trauma should be targeted based on these factors. [ABSTRACT FROM AUTHOR]

Sex disparities have been reported in the prehospital and in-hospital care among patients with out-of-hospital cardiac arrest (OHCA). The aim of this study was to investigate the association between sex and prehospital advanced cardiac life support (ACLS) interventions provided by emergency medical services (EMS). This was a cross-sectional observational study using a nationwide OHCA registry in South Korea. The study included adult OHCAs with presumed cardiac etiology from January 2016 to December 2019. The main exposure was the sex of the victim, and the primary outcomes were prehospital ACLS interventions, including advanced airway management (AAM), intravenous access (IV), and epinephrine (EPI) administration. Multivariable logistic regression analysis accounted for age group, health insurance, comorbidities, place of arrest, urbanization level, witness status, bystander CPR and initial rhythm was performed to calculate adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs). Among 71,154 eligible patients, females with OHCA received less prehospital ACLS interventions than males: risk difference, (95% CIs) −2.76 (-3.41;-2.11) for AAM, −6.03 (-6.79;-5.27) for IV, and −3.81 (-4.37;-3.25) for EPI. In multivariable logistic regression analysis, female sex was significantly associated with a lower probability of prehospital ACLS provision: AOR, (95% CIs) 0.87 (0.84-0.91) for AAM, 0.85 (0.82-0.88) for IV, and 0.81 (0.77-0.84) for EPI. Compared to male patients, female patients were less likely to receive prehospital ACLS. This offers opportunities for EMS systems to reduce disparities and to improve compliance with OHCA resuscitation guidelines and outcomes through quality improvement and educational interventions. [ABSTRACT FROM AUTHOR]

Objectives: Area‐level socioeconomic status (SES) is associated with the incidence of out‐of‐hospital cardiac arrest (OHCA); however, the effects of individual‐level SES on OHCA occurrence are unknown. This study investigated whether individual‐level SES is associated with the occurrence of OHCA. Methods: This case–control study used data from the nationwide OHCA registry and the National Health Information Database (NHID) in Korea. All adult patients with OHCA of a medical etiology from 2013 to 2018 were included. Four controls were matched to each OHCA patient based on age and sex. The exposure was individual‐level SES measured by insurance type and premium, which is based on income in Korea. National Health Insurance (NHI) beneficiaries were divided into four groups (Q1–Q4), and medical aid beneficiaries were separately classified as the lowest SES group. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the outcomes were calculated. Stratified analyses were conducted according to age and sex. Results: A total of 105,443 cases were matched with 421,772 controls. OHCA occurred more frequently in the lower SES groups. Compared with the highest SES group (Q1), the aORs for OHCA occurrence increased as the SES decreased (aORs [95% CI] were 1.21 [1.19–1.24] for Q2, 1.33 [1.31–1.36] for Q3, 1.32 [1.30–1.35] for Q4, and 2.08 [2.02–2.13] for medical aid). Disparity by individual‐level SES appeared to be greater in males than in females and greater in the young and middle‐aged adults than in older adults. Conclusions: Low individual‐level SES was associated with a higher probability of OHCA occurrence. Efforts are needed to reduce SES disparities in the occurrence of OHCA. [ABSTRACT FROM AUTHOR]

Objective: Major trauma is a major concern in public health and a leading cause of mortality worldwide. This study aimed to evaluate the association between the prehospital scene time interval (STI) and survival in emergency medical service (EMS)-assessed major trauma patients admitted to the intensive care unit (ICU). Methods: A retrospective observational study using the Pan-Asian Trauma Outcomes Study (PATOS) database was conducted. Adult trauma patients with injury severity scores (ISSs) greater than 15 who were admitted to the ICU were selected. EMS STIs were categorized into three groups: short (0–8 minutes), intermediate (9–16 minutes), and long (over 16 minutes). The primary outcome was survival to hospital discharge, and the secondary outcome was good neurological outcome at hospital discharge. Multivariable logistic regression analysis was conducted to calculate odds ratios and confidence intervals, adjusting for age, sex, mechanism of injury, prehospital alertness, prehospital shock index, response time interval, and EMS intervention (airway, oxygen supplementation, and intravenous fluid administration). Sensitivity analysis for patients who underwent surgery or nontraumatic brain injury cases and interaction analysis by EMS intervention were performed. Results: Data from a total of 1,874 eligible patients were analyzed. Intermediate and long STIs showed significant associations with outcomes, with adjusted ORs (95% CI) of 1.21 (1.07–1.38) in the intermediate STI group and 1.74 (1.55–1.96) in the long STI group for survival and 1.37 (1.32–1.40) in the intermediate STI group and 1.31 (1.22–1.41) in the long STI group for neurological outcome. In the sensitivity analysis, the highest ORs were found in the intermediate STI group, with adjusted ORs (95% CI) of 1.40 (1.37–1.42) for survival and 1.32 (1.26–1.38) for neurological outcome. In the interaction analysis, EMS intervention showed a positive interaction effect with an intermediate STI on survival. Conclusion: In EMS-assessed adult major trauma patients admitted to the ICU, we found significant associations between STIs longer than 8 minutes and outcomes. EMS intervention has a positive interaction effect with an intermediate STI on survival. More research is needed to understand the implications of practice for major trauma in the field. [ABSTRACT FROM AUTHOR]

Background: Calcium level is associated with sudden cardiac death based on several cohort studies. However, there is limited evidence on the association between ionized calcium, active form of calcium, and resuscitation outcome. This study aimed to evaluate the potential role of ionized calcium in predicting resuscitation outcome in patients with out-of-hospital cardiac arrest. Methods: We analyzed the Korean Cardiac Arrest Research Consortium data (KoCARC) registry, a web-based multicenter registry that included 65 participating hospitals throughout the Republic of Korea. The patients with out-of-hospital cardiac arrest over 19 years old and acquired laboratory data including calcium, ionized calcium, potassium, phosphorus, creatinine, albumin at emergency department (ED) arrival were included. The primary outcome was successful rate of return of spontaneous circulation (ROSC) and the secondary outcomes were survival hospital discharge and favorable neurological outcome (cerebral performance category 1 or 2) at hospital discharge. Results: Eight-hundred and eighty-three patients were enrolled in the final analysis and 448 cases (54%) had ROSC. In multivariable logistic regression analysis, ionized calcium level was associated with ROSC (odds ratio, 1.77; 95% CI1.28–2.45; p = 0.001) even though calcium level was not associated with ROSC (odds ratio, 0.87; 95% CI 0.70–1.08; p = 0.199). However, ionized calcium level was not associated with survival discharge (odds ratio, 0.99; 95% CI 0.72–1.36; p = 0.948) or favorable neurologic outcome (odds ratio, 0.45; 95% CI 0.03–6.55, p = 0.560). Conclusion: A high ionized calcium level measured during cardiopulmonary resuscitation was associated with an increased likelihood of ROSC. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the association between coronary angiography (CAG) with and without percutaneous coronary intervention (PCI) after out-of-hospital cardiac arrest (OHCA) and neurological recovery and to determine the influence of primary electrocardiogram or patient age on the effects of CAG. Methods: Adult patients with OHCA with cardiac etiology who were admitted to PCI-capable hospitals from 2016 to 2017 were enrolled in this study from the nationwide OHCA registry of Korea. Coronary intervention was categorized into three groups: No CAG, CAG without PCI, and CAG with PCI. The endpoint was good neurological recovery. Multivariable logistic regression and interaction analyses (intervention × electrocardiogram and intervention × age) were conducted by calculating adjusted odds ratios (aORs) and 95% confidence intervals (CI). Results: Of a total of 6,802 eligible OHCA patients, 1,218 (17.9%) underwent CAG without PCI and 1,136 (16.7%) underwent CAG with PCI. The CAG without PCI and CAG with PCI groups were more likely to have good neurological recovery than the No CAG group (57.4% vs. 61.6% vs. 16.3%; 3.39 [2.83–4.06] for CAG without PCI and 3.32 [2.74–4.01] for CAG with PCI). Interaction analysis showed that although the effect size differed according to patient characteristics, both CAG groups were associated with an increased likelihood of good neurological recovery, regardless of primary electrocardiogram and age group. In younger patients, CAG with PCI had greater outcome benefits than CAG without PCI (8.54 [4.31–16.95] vs. 4.10 [2.69–6.24]), whereas CAG without PCI had a larger effect size than CAG with PCI in elderly patients (4.46 [2.59–7.68] vs. 2.92 [1.80–4.73]) (p value for interaction 0.02). Conclusions: Post-resuscitation CAG with and without PCI are associated with better neurological recovery in patients with OHCA, regardless of primary electrocardiogram and patient age. [ABSTRACT FROM AUTHOR]

Aims: This study aims to test the association between the place-provider-matrix (PPM) of bystander cardiopulmonary resuscitation (CPR) and outcomes of out-of-hospital cardiac arrest (OHCA). Methods: Adult patients with OHCA with a cardiac etiology from 2012 to 2017 in Korea were analyzed, excluding patients who had unknown information on place, type of bystander, or outcome. The PPM was categorized into six groups by two types of places (public versus home) and three types of providers (trained responder (TR), family bystander, and layperson bystander). Outcomes were survival to discharge and good cerebral performance category (CPC) of 1 or 2. Multivariable logistic regression analysis was performed to test the association between PPM group and outcomes with adjustment for potential confounders to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) (reference = Public-TR). Results: A total of 73,057 patients were analyzed and were categorized into Public-TR (0.6%), Home-TR (0.3%), Public-Family (1.8%), Home-Family (79.8%), Public-Layperson (9.9%), and Home-Layperson (7.6%) groups. Compared with the Public-TR group, the AORs (95% CIs) for survival to discharge were 0.61 (0.35–1.05) in the Home-TR group, 0.85 (0.62–1.17) in the Public-Family group, 0.38 (0.29–0.50) in the Home-Family group, 1.12 (0.85–1.49) in the Public-Layperson group, and 0.42 (0.31–0.57) in the Home-Layperson group. The AORs (95% CIs) for good CPC were 0.58 (0.27–1.25) in the Home-TR group, 0.88 (0.61–1.27) in the Public-Family group, 0.38 (0.28–0.52) in the Home-Family group, 1.20 (0.87–1.65) in the Public-Layperson group, and 0.42 (0.30–0.59) in the Home-Layperson group. Conclusion: The OHCA outcomes of the Home-Family and Home-Layperson groups were worse than those of the Public-TR group. This finding suggests that OHCA occurring in private places with family or layperson bystanders requires a new strategy, such as dispatching trained responders to the scene to improve CPR outcomes. [ABSTRACT FROM AUTHOR]

Objective: A multi-tiered response (MTR) system has been controversial in terms of cost-effectiveness and outcome improvement. It remains uncertain whether a cardiopulmonary resuscitation (CPR)-targeted tiered response system is associated with better outcomes after out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the effect of an MTR on OHCA outcomes. Methods: A natural experimental study was conducted for resuscitation-attempted adult OHCAs. The MTR system was implemented in Korea by the National Fire Agency in 2015 across the country where the single-tiered ambulance response system existed. The MTR program had the following 3 components: 1) detection of OHCA by dispatcher, 2) dispatch of ambulance or fire engine in addition to routine dispatch of ambulance, and 3) performance of team CPR. The study period of 2015–2016 was divided by 6 months (phases I [reference], II, III, and IV). The endpoints were prehospital defibrillation, prehospital return of spontaneous circulation (PROSC), survival to discharge and good neurological recovery. A multivariable logistic regression analysis was performed to evaluate the effect of the intervention, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, adjusting for potential confounders. Results: A total of 32,663 eligible OHCA cases were evaluated during the study period. As the intervention program spread, the MTR with ambulance increased (from 7.0% in phase I to 53.7% in phase IV, p for trend < 0.01). During the study period, prehospital defibrillation increased from 23.6% in phase I to 26.9% in phase IV and the study outcome was improved from 7.4 to 12.6% for PROSC, from 6.7 to 9.1% for survival to discharge, and from 4.5 to 5.8% for good neurological outcome (p for trend < 0.01 for all). Compared with phase I, the AORs (95% CI) of phase IV were 1.16 (1.08–1.25) for prehospital defibrillation, 1.82 (1.63–2.04) for PROSC, 1.37 (1.21–1.56) for survival to discharge, and 1.23 (1.06–1.43) for good neurological outcome. Conclusion: The nationwide implementation of a multi-tiered response system for OHCA was associated with increased prehospital defibrillation and improved outcomes of OHCA patients. [ABSTRACT FROM AUTHOR]

Objective: To minimize risk and prevent harmful incidents during interhospital transport, the critical care transport unit service called Seoul Mobile Intensive Care Unit (SMICU) was organized and initiated its service within the city of Seoul. We sought to evaluate the effectiveness of critical care transport units on outcomes of critically ill patients undergoing interhospital transport in Seoul. Methods: A retrospective observational case–control study was designed to evaluate the effectiveness of critical care transport units on outcomes of critically ill patients undergoing interhospital transport. ED patients transported from other hospitals in Seoul during 2016 were identified in the National Emergency Department Information System (NEDIS) and according to use of the SMICU. One-to-one propensity matching was performed to balance covariates between groups. The association of SMICU transport on survival outcome was calculated in a multivariable logistic regression model. Results: Among 42,188 ED patients transported from other hospitals in 2016, 482 (1.1%) of patients were transported by SMICU. Patients transported by SMICU had a higher proportion of severe emergency disease and use of a mechanical ventilator. The adjusted odds ratio for 24-hour mortality after interhospital transport was 0.45 (95% CI: 0.26–0.81) in total cohort and was 0.34 (95% CI: 0.16–0.71) in a one-to-one propensity-matched cohort. Conclusions: Transport by specialized critical care transport unit for patients undergoing interhospital transport was associated with lower 24-hour mortality, demonstrating the benefits of the SMICU. [ABSTRACT FROM AUTHOR]

Objectives: The association between the time from arrest to extracorporeal cardiopulmonary resuscitation (ECPR) and survival from out‐of‐hospital cardiac arrest (OHCA) is unclear. The aim of this study was to determine whether time to ECPR is associated with survival in OHCA. Methods: We analysed the Korean national OHCA registry from 2013 to 2016. We included adult witnessed OHCA patients with presumed cardiac aetiology who underwent ECPR. Patients were excluded if their arrest times or outcomes were unknown. The primary outcome was survival to discharge. Multivariable logistic regression analysis controlling for potential confounders was conducted and adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated to determine the association between time to ECPR and survival. Results: There were 40 352 witnessed OHCAs with presumed cardiac aetiology. One hundred and forty patients had ECPR applied on arriving at their ED, 13 of these patients survived to discharge and seven were neurologically intact. Median time from arrest to ECPR was 74 min (IQR 61–90). Time from arrest to ECPR was significantly and inversely associated with survival to discharge for every 10 min increase in time (AOR 0.73, 95% CI 0.53–1.00) in 10 min intervals. AOR for time from arrest to ECPR ≤60 min was independently associated with improved survival (AOR 6.48, 95% CI 1.54–27.20). Conclusion: Early initiation of ECPR is associated with improved survival after OHCA. Because we analysed a nationwide OHCA registry, which lacks uniform selection criteria for ECPR, further prospective study is warranted. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether effect size of the hypoxia is different on in-hospital mortality and disability according to hypotension status in the field. Methods: Adult severe trauma (ST) patients during 2012-13 who were treated by emergency medical services (EMS) and had abnormal revised trauma scores in the field or who had positive trauma triage criteria were analyzed. Exposure was hypoxia (<94%) measured by EMS. End points were hospital mortality and disability defined as a Glasgow Outcome Scale that decreased by 2 points or more. Multivariable logistic regression with interaction model between hypoxia and hypotension was used for outcomes to calculate the adjusted odds ratios (AOR) with 95% confidence intervals (95% CIs) after adjusting for potential confounders. Results: A total of 17,406 EMS-ST patients were analyzed. Of those, 2,598 (14.9%) died, and 3,292 (21.5%) were considered disabled at discharge. The total hypoxia group showed higher mortality and disability indices (35.7 and 51.2%) than the non-hypoxia group (10.7 and 15.9%) (each p-value < 0.0001). The AOR of hypoxia was 2.15 (1.92-2.40) for mortality and was 1.97 (1.75-2.21) for disability. In the interaction model, AORs for mortality by hypoxia in the hypotensive and non-hypotensive groups were 2.66 (2.32-3.04) and 1.74 (1.61-1.87), respectively (P < 0.0001 for interaction). The AORs for disability in the hypotensive and non-hypotensive groups were 2.17 (1.87-2.53) and 1.55 (1.42-1.69), respectively (P < 0.0001 for interaction). Conclusions: The effect of hypoxia was much greater in the hypotensive group than in the non-hypotensive group both in terms of mortality and disability. [ABSTRACT FROM AUTHOR]

Purpose: Korean national emergency care protocol for EMS providers recommends a minimum of 5 minutes of on-scene resuscitation before transport to hospital in cases of Out-of-Hospital Cardiac Arrest (OHCA). We compared survival outcome of OHCA patients according to scene time interval (STI)-protocol compliance of EMS. Methods: EMS treated adult OHCAs with presumed cardiac etiology during a two-year period were analyzed. Non-compliance was defined as hospital transport with STI less than 6 minutes without return of spontaneous circulation (ROSC) on scene. Propensity score for compliance with protocol was calculated and based on the calculated propensity score, 1:1 matching was performed between compliance and non-compliance group. Univariate analysis as well as multivariable logistic model was used to evaluate the effect of compliance to survival outcome. Results: Among a total of 28,100 OHCAs, EMS transported 7,026 (25.0%) cardiac arrests without ROSC on the scene with an STI less than 6 minutes. A total of 6,854 cases in each group were matched using propensity score matching. Overall survival to discharge rate did not differ in both groups (4.6% for compliance group vs. 4.5 for non-compliance group, p = 0.78). Adjusted odds ratio of compliance for survival to discharge were 1.12 (95% CI 0.92-1.36). More patients with favorable neurological outcome was shown in compliance group (2.5% vs. 1.7%, p < 0.01) and adjusted odds ratio was 1.91 (95% CI 1.42-2.59). Conclusions: Although survival to discharge rate did not differ for patient with EMS non-compliance with STI protocol, lesser patients survived with favorable neurological outcomes when EMS did not stay for sufficient time on scene in OHCA before transport. [ABSTRACT FROM AUTHOR]

Background: Trauma is a major health burden and a time-dependent critical emergency condition among developing and developed countries. In Asia, trauma has become a rapidly expanding epidemic and has spread out to many underdeveloped and developing countries through rapid urbanization and industrialization. Most casualties of severe trauma, which results in significant mortality and disability are assessed and transported by prehospital providers including physicians, professional providers, and volunteer providers. Trauma registries have been developed in mostly developed countries and measure care quality, process, and outcomes. In general, existing registries tend to focus on inhospital care rather than prehospital care. Methods: The Pan-Asia Trauma Outcomes Study (PATOS) was proposed in 2013 and initiated in November, 2015 in order to establish a collaborative standardized study to measure the capabilities, processes and outcomes of trauma care throughout Asia. The PATOS is an international, multicenter, and observational research network to collect trauma cases transported by emergency medical services (EMS) providers. Data are collected from the participating hospital emergency departments in various countries in Asia which receive trauma patients from EMS. Data variables collected include 1) injury epidemiologic factors, 2) EMS factors, 3) emergency department care factors, 4) hospital care factors, and 5) trauma system factors. The authors expect to achieve a sample size of 67,230 cases over the next 2 years of data collection to analyze the association between potential risks and outcomes of trauma. Conclusion: The PATOS network is expected to provide comparison of the trauma EMS systems and to benchmark best practice with participating communities. [ABSTRACT FROM AUTHOR]

Objective:Prehospital time potentially impacts clinical outcomes in severely injured trauma patients. The importance of individual components, including scene and response time, however, is controversial. Our objective was to determine the impact of prehospital times on survival in severely injured patients.Methods:We reviewed injured trauma patients enrolled in a Korean EMS trauma registry during 2012. Severe trauma patients were defined as having either a “V” or lower in the AVPU system, a systolic blood pressure ≤90mmHg, or respiratory rate <10 or >29. Patients with Injury Severity Scores(ISS) < 9 were excluded. Patients were categorized by scene time into 4 groups as follows: <3 minutes, 3–6 minutes, 6–9 minutes, and ≥9 minutes and by prehospital time as follows: <16 minutes, 16–24 minutes, 24–32 minutes, and ≥32 minutes. The primary outcome was in-hospital mortality. Multiple linear regression analysis was used to adjust for possible confounders.Results:A total of 2,257 eligible patients were analyzed. Scene time was <3 minutes in 220 (9.7%), 3–6 in 865 (38.3%), 6–9 in 587 (26.0%), and ≥9 in 585 (25.9%). In-hospital mortality was 396 (17.5%). Compared to a scene time 6 to 9 minutes, mortality was higher as the scene time decreased: odds ratio (OR) = 1.3(3 to <6), OR = 1.9(0 to <3). Mortality was slightly decreased as prehospital time increased, OR = 1.0(16 to <24), OR = 0.9(24 to <32), OR = 0.7(≥32).Conclusion:Longer prehospital times did not increase mortality in severely injured trauma patients in Korea. Furthermore, longer scene times were associated with lower mortality. [ABSTRACT FROM PUBLISHER]

Objective The present study aimed to determine the relationship between the triage-based resource allocation and clinical treatment ( TRACT) protocol and mortality and length of stay ( LOS) in ED. Methods This before-and-after study was conducted in an adult, tertiary, teaching hospital ED from August 2008 to July 2012. Patients who were younger than 18 years of age, who were dead on arrival and whose triage information was not available were excluded. TRACT was implemented in August 2010, and the Emergency Severity Index ( ESI) was used for triage. Primary and secondary outcomes were ED mortality and ED LOS. Multivariate logistic regression models for ED mortality and multivariable general linear models on the ED LOS were used to compare the before- and after-intervention periods. Results For the 155 563 visits over study period, the ED mortality rate was 0.2%, and the ED LOS was 4.6 h (median). The adjusted odds ratios (95% confidence intervals [CIs]) of the TRACT protocol on ED mortality were 0.69 (0.54-0.88) for total patients, 0.42 (0.30-0.59) for ESI 1, 1.04 (0.66-1.65) for ESI 2 and 1.45 (0.76-2.75) for ESI 3 group. The adjusted coefficients (95% CIs) of the TRACT on the ED LOS were −88.1 (−96.9 ∼ −79.2) min for all patients, −44.9 (−72.0 ∼ −17.9) min for ESI level 2 and −104.3 (−114.7 ∼ −94.0) min for ESI level 3. Conclusions The TRACT protocol decreased the ED mortality in ESI 1 group and reduced the ED LOS in ESI levels 2 and 3 groups. [ABSTRACT FROM AUTHOR]

Purpose: Awareness of out-of-hospital cardiac arrest (OHCA) is critically important for bystanders to receive early instruction of dispatch-assisted cardiopulmonary resuscitation (DA-CPR) as well as to call for ambulance services. This study aimed to determine the association between awareness time interval and outcomes.Methods: EMS-treated, witnessed, adult (≥18 years old) OCHAs with presumed cardiac etiology between 2012 and 2017 were analyzed, excluding patients with unknown awareness time factors and outcomes. The main exposure was awareness time interval (ATI), defined as the time from the witnessed event to calling for ambulance. Patients were categorized into five groups according to ATI: Group 1 (0-1 min), Group 2 (2-3 min), Group 3 (4-5 min), Group 4 (6-30 min) and Group 5 (31-60 min). The primary outcome was good neurological recovery defined as cerebral performance category 1 or 2 (good CPC). Multivariable logistic regression analysis was performed to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for outcomes by ATI group (reference = Group 1) and by one-minute delay. We compared the effect size of ATI on outcomes across three witness groups (Layperson, Family, and Unknown).Results: A total of 36,809 OHCAs were analyzed. The AOR (95% CI) by one-minute ATI delay was 0.91 (0.90-0.92) for good CPC. The AORs (95% CIs) for outcomes compared with Group 1 were 0.98 (0.88-1.09) for Group 2, 0.64 (0.56-0.74) for Group 3, 0.30 (0.26-0.35) for Group 4, and 0.10 (0.05-0.20) for Group 5. In the Family bystander group, AORs (95% CIs) compared with Group 1 were significantly decreased by delay of ATI; 1.04 (0.88-1.11) for Group 2, 0.63 (0.81-0.83) for Group 3, and 0.31 (0.31-0.40) for Group 4 and 5. In Layperson-witnessed OHCAs, however, the AORs were significantly higher in the delayed awareness groups (Group 2 and Group 3).Conclusion: A longer ATI in witnessed adult OHCAs was associated with poor neurological recovery. A one-minute delay in ATI was associated with a 9% decrease of good neurological recovery, and the effect was significantly increased in Family-witnessed OHCAs. [ABSTRACT FROM AUTHOR]

Background: This study aims to test the association between capacity of cardiopulmonary resuscitation (CPR) at community level and survival after out-of-hospital cardiac arrest (OHCA).Methods: Emergency medical service (EMS)-treated OHCAs with cardiac etiology in Korea between 2012 and 2013 were analyzed, excluding cases witnessed by EMS providers. Exposure variables were five indexes of community CPR capacity: awareness of CPR (CPR-Awareness), any training experience of CPR (CPR-Any-Training), recent CPR training within the last 2 years (CPR-Recent-Training), CPR training with a manikin (CPR-Manikin-Training), and CPR self-efficacy (CPR-Self-Efficacy). All measures of capacity were calculated as aggregated values for each county level using the national Korean Community Health Survey database of 228,921 responders sampled representatively from 253 counties in 2012. Endpoints were bystander CPR (BCPR) and survival to discharge. We calculated adjusted odds ratios (AORs) per 10% increment in community CPR capacity using multi-level logistic regression models, adjusting for potential confounders at individual levels.Results: Of 29,052 eligible OHCAs, 11,079 (38.1%) received BCPR. Patients were more likely to receive BCPR in communities with higher proportions of residents with CPR-Awareness, CPR-Any-Training, CPR-Recent-Training, CPR-Manikin-Training, and CPR-Self-Efficacy (all p<0.01). AORs for BCPR were 1.06 (1.03-1.10) per 10% increment in CPR-Awareness, 1.10 (1.04-1.15) for CPR-Any-Training, and 1.08 (1.03-1.13) for CPR-Self-Efficacy. For survival to discharge, AORs (95% CIs) were 1.34 (1.23-1.47) per 10% increment in CPR-Awareness, 1.36 (1.20-1.54) for CPR-Any-Training, and 1.29 (1.15-1.45) for CPR-Self-Efficacy.Conclusion: Higher CPR capacity at community level was associated with higher bystander CPR and survival to discharge rates after OHCA. [ABSTRACT FROM AUTHOR]

Aims: We investigated the impact of healthy lifestyle factors and cardiovascular comorbidities for sudden cardiac arrest.Methods: A case-control study, including patients with sudden cardiac arrest aged 20-79 years and community-based 1:2 matched controls, was conducted from September 2017 to December 2020. All participants completed a structured questionnaire. Using multivariable logistic regression, we assessed cardiovascular comorbidities (diabetes, hypertension, dyslipidaemia, myocardial infarction, congestive heart failure, arrhythmia, and stroke) and healthy lifestyle factors (low red meat consumption, low fish consumption, high fruit consumption, high vegetable consumption, current non-smoking, regular exercise, and adequate sleep duration) as sudden cardiac arrest risk factors.Results: Among 3027 eligible cases, informed consent was obtained from 949 (31.3%) cases. A total of 1731 controls were enrolled. Cardiovascular comorbidities, except dyslipidaemia, were associated with an increased risk of sudden cardiac arrest, whereas all healthy lifestyle factors were associated with a decreased risk. Relative to patients in the 0-2 healthy lifestyle factors group, the adjusted odds ratio (95% confidence interval) for sudden cardiac arrest was 0.25 (0.16-0.40) in patients with 3 healthy lifestyle factors, 0.08 (0.05-0.13) in patients with 4 healthy lifestyle factors, and 0.04 (0.03-0.06) in patients with over 5 healthy lifestyle factors. When the number of healthy lifestyle factors was analysed as a continuous variable, each additional factor was associated with a significant decrease in the likelihood of sudden cardiac arrest (adjusted odds ratio [95% confidence interval]: 0.41 [0.36-0.46]).Conclusion: The increased risk of sudden cardiac arrest by cardiovascular comorbidities could be significantly reduced with healthy lifestyle factors. [ABSTRACT FROM AUTHOR]

Background: Prehospital application of a mechanical chest compression device (MCD) and post-cardiac arrest (PCA) care including coronary reperfusion therapy (CRT) or targeted temperature management (TTM) could affect the clinical outcome in out-of-hospital cardiac arrest (OHCA).Objectives: This study aimed to assess whether the effect of PCA care including CRT or TTM differs according to prehospital MCD use in patients with OHCA.Methods: Adult OHCA cases with a presumed cardiac etiology and with survival to admission from 2016 to 2017 were enrolled from the Korean nationwide OHCA registry. The main exposures were CRT and TTM during PCA care. The primary outcome was good neurologic recovery defined by a cerebral performance category score of 1 or 2 at hospital discharge. We conducted interaction analyses between MCD use and PCA care including CRT or TTM.Results: Four thousand three hundred sixty-six OHCA cases were enrolled and 7.9% underwent MCD application. TTM and CRT were performed in 11.2% and 17.9% of the study population. In the interaction analysis, the adjusted odds ratios of TTM and CRT for good neurologic recovery were 2.41 (1.90-3.06) and 3.40 (2.79-4.14) in patients without MCD use and 1.89 (0.97-3.68), and 1.54 (0.79-3.01) in patients with MCD use.Conclusions: The effect of PCA care on neurologic outcomes was different according to MCD use in OHCA. The association of good neurologic outcome and PCA care was not observed in the prehospital MCD use group compared with that in the MCD nonuse group. [ABSTRACT FROM AUTHOR]

Background: There are few studies on the use of a mechanical chest compression (meCC) device during transport in patients with out-of-hospital cardiac arrest (OHCA).Objective: The aim of our study was to compare the performance of an meCC device with that of manual chest compression during transport after OHCA.Methods: This study used data from the national cardiac arrest registry of patients with OHCA of presumed cardiac etiology. The primary exposure was the use of an meCC device by an Emergency Medical Services provider while transporting a patient to the emergency department. The primary endpoint was good cerebral performance category at discharge. We compared survival and neurologic outcomes between an meCC device group and a manual chest compression group. We also performed an interaction analysis to assess changes in study outcomes of meCC device use by the initial electrocardiogram (ECG) and transport time interval (TTI).Results: Among 30,021 adult patients after OHCA with presumed cardiac etiology, an meCC device was used in 2357 (7.6%). After adjustment for possible confounders, there were no significant differences with respect to good neurologic recovery in the outcomes of patients who were treated with an meCC device and those who received manual chest compression (adjusted odds ratio [AOR] 0.66; 95% confidence interval [CI] 0.43-1.02) and survival to discharge (AOR 0.83; 95% CI 0.64-1.06). In the interaction model, the AOR of the meCC device study outcome did not interact with the initial ECG and TTI.Conclusions: The meCC device did not show better study outcomes than manual compression. [ABSTRACT FROM AUTHOR]

Objectives: There is growing evidence that optimal post-resuscitation treatment is a significant factor for overall survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA). However, there is also growing evidence of disparities in treatments in vulnerable populations such as elderly individuals or patients with underlying diseases, including cancer.Aim: The aim of this study was to evaluate the influence of cancer status on post-resuscitation therapies among OHCA patients.Material and Methods: This was a cross-sectional observational study based on a nationwide prospective OHCA registry database of Korea. All adult OHCA patients with presumed cardiac etiology and sustained return of spontaneous circulation (ROSC) from 2009 to 2016 were included in this study. Main exposure was history of cancer and primary outcome was post-resuscitation care, including percutaneous coronary intervention (PCI) and targeted temperature management (TTM). Multivariable logistic regression was used to analyze the association between cancer and post-resuscitation treatments.Results: A total of 33,760 patients were included for final analysis. Multivariable logistic analysis showed that cancer patients were significantly less likely to receive PCI and TTM compared to those without history of cancer with adjusted odds ratios of 0.29 (95% CI: 0.24-0.37) and 0.66 (0.58-0.77), respectively.Conclusion: The results of this study suggest that a prior history of cancer may be associated with lower probability to receive potentially beneficial post-resuscitation treatments. [ABSTRACT FROM AUTHOR]