Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand.
Prehosp Emerg Care. 2023;27(2):196-204. doi: 10.1080/10903127.2022.2058131. Epub 2022 Apr 12.
Out-of-hospital cardiac arrest (OHCA) remains a health problem worldwide, carrying a high mortality rate. Comparison of emergency department (ED) return of spontaneous circulation (ROSC) after OHCA in relation to emergency medical services (EMS) and non-EMS modes of transportation to the hospital was conducted to assess the impact points of the EMS system in Thailand.
This retrospective observational study enrolled all OHCA patients who visited the ED of Ramathibodi Hospital, a tertiary university hospital in Bangkok, between January 1, 2008, and May 31, 2020. Patients were differentiated into EMS and non-EMS groups according to mode of transportation to the ED. Patients' characteristics and comorbidities, witnessed arrests, bystander chest compression, initial rhythm, and resuscitation treatment were documented. ED-sustained ROSC, ED survival, 30-day survival, and 30-day survival with good cerebral performance category (CPC) scores were monitored and recorded. Multivariate logistic analyses were performed to assess factors influencing clinical outcomes.
A total of 339 patients were enrolled, 117 (34.51%) of whom were in the EMS transport group. There were no differences between the EMS and non-EMS groups in ED-sustained ROSC (adjusted odds ratio [aOR], 0.99; 95% confidence interval [CI], 0.58-1.70; = 0.98), or ED survival (aOR, 0.99; 95% CI, 0.57-1.71; = 0.97). There were also no differences in 30-day survival or 30-day survival with good CPC score between the two groups.
In our cohort data of OHCA, ED-sustained ROSC and ED survival outcomes were not superior in the EMS transportation group. Evidence to show that EMS transportation affected 30-day survival and 30-day good CPC score was also lacking. Thus, public promotion of Thailand's EMS system is advocated with a simultaneous improvement of EMS response to enhance OHCA outcomes.
院外心脏骤停（OHCA）仍然是一个全球性的健康问题，死亡率很高。本研究比较了 OHCA 患者经急救医疗服务（EMS）和非 EMS 模式转送至医院后急诊科（ED）自主循环恢复（ROSC）的情况，以评估泰国 EMS 系统的影响点。
这是一项回顾性观察性研究，纳入了 2008 年 1 月 1 日至 2020 年 5 月 31 日期间访问曼谷 Ramathibodi 医院 ED 的所有 OHCA 患者。根据转运至 ED 的方式将患者分为 EMS 和非 EMS 组。记录患者的特征和合并症、目击者心脏骤停、旁观者胸外按压、初始节律和复苏治疗。监测并记录 ED 持续 ROSC、ED 生存、30 天生存和 30 天生存且具有良好的神经功能预后（CPC）评分。进行多变量逻辑分析以评估影响临床结局的因素。
共纳入 339 例患者，其中 117 例（34.51%）为 EMS 转运组。EMS 转运组和非 EMS 转运组在 ED 持续 ROSC（调整优势比[aOR]，0.99；95%置信区间[CI]，0.58-1.70； = 0.98）或 ED 生存（aOR，0.99；95% CI，0.57-1.71； = 0.97）方面无差异。两组间 30 天生存或 30 天生存且具有良好 CPC 评分亦无差异。
在我们的 OHCA 队列数据中，ED 持续 ROSC 和 ED 生存结局在 EMS 转运组中并未更优。也缺乏证据表明 EMS 转运影响 30 天生存和 30 天良好 CPC 评分。因此，提倡宣传泰国的 EMS 系统，并同时提高 EMS 反应速度，以改善 OHCA 结局。
