Prehospital factors associated with out-of-hospital cardiac arrest outcomes in a metropolitan city: a 4-year multicenter study

Jae Yun Ahn; Hyun Wook Ryoo; Sungbae Moon; Haewon Jung; Jungbae Park; Won Kee Lee; Jong-Yeon Kim; Dong Eun Lee; Jung Ho Kim; Sang-Hun Lee

doi:10.1186/s12873-023-00899-3

Prehospital factors associated with out-of-hospital cardiac arrest outcomes in a metropolitan city: a 4-year multicenter study

BMC Emerg Med. 2023 Oct 26;23(1):125. doi: 10.1186/s12873-023-00899-3.

Authors

Affiliations

¹ Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
² Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea. ryoo@knu.ac.kr.
³ Department of Biostatistics, School of Medicine, Medical Research Collaboration Center, Kyungpook National University, Daegu, Republic of Korea.
⁴ Department of Public Health, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
⁵ Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
⁶ Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
⁷ Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea.

Abstract

Background: Prehospital factors play a vital role in out-of-hospital cardiac arrest (OHCA) survivability, and they vary between countries and regions. We investigated the prehospital factors associated with OHCA outcomes in a single metropolitan city in the Republic of Korea.

Methods: This study included adult medical OHCA patients enrolled prospectively, using data from the citywide OHCA registry for patients registered between 2018 and 2021. The primary outcome was survival to hospital discharge. Multivariable logistic regression analysis was conducted to determine the factors associated with the study population's clinical outcomes, adjusting for covariates. We performed a sensitivity analysis for clinical outcomes only for patients without prehospital return of spontaneous circulation prior to emergency medical service departure from the scene.

Results: In multivariable logistic regression analysis, older age (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.95-0.97), endotracheal intubation (adjusted odds ratio [aOR] 0.29; 95% [CIs] 0.17-0.51), supraglottic airway (aOR 0.29; 95% CI 0.17-0.51), prehospital mechanical chest compression device use (OR 0.13; 95% CI 0.08-0.18), and longer scene time interval (OR 0.96; 95% CI 0.93-1.00) were negatively associated with survival. Shockable rhythm (OR 24.54; 95% CI 12.99-42.00), pulseless electrical activity (OR 3.11; 95% CI 1.74-5.67), and witnessed cardiac arrest (OR 1.59; 95% CI 1.07-2.38) were positively associated with survival. In the sensitivity analysis, endotracheal intubation, supraglottic airway, prehospital mechanical chest compression device use, and longer scene time intervals were associated with significantly lower survival to hospital discharge.

Conclusions: Regional resuscitation protocol should be revised based on the results of this study, and modifiable prehospital factors associated with lower survival of OHCA should be improved.

Keywords: Advanced cardiac life support; Out-of-hospital cardiac arrest: emergency medical services; Survival.

Publication types

Multicenter Study

MeSH terms

Adult
Cardiopulmonary Resuscitation* / methods
Emergency Medical Services* / methods
Humans
Intubation, Intratracheal
Out-of-Hospital Cardiac Arrest* / therapy
Registries