Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea.
Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea.
Am J Emerg Med. 2022 Jun;56:211-217. doi: 10.1016/j.ajem.2022.03.050. Epub 2022 Mar 31.
The aim of this study was to compare out-of-hospital cardiac arrest (OHCA) outcomes before and after implementation of Smart Advanced Life Support (SALS) protocol incorporating changes in cardiopulmonary resuscitation (CPR) assistance and coaching by physicians via real-time video calls.
A prospective before-and-after multi-regional observational study was conducted between January 2014 and December 2018. In January 2016, emergency medical service (EMS) providers adopted an integrated CPR coaching by physicians via real-time video call via SALS to treat patients with OHCA focusing on high-quality cardiopulmonary resuscitation. Propensity score matching was performed to match patients. Patients' outcomes using conventional protocol were then compared with those of patients using the SALS protocol.
Among 26,349 OHCA cases, 2351 patients and 7261 patients were enrolled during the pre-intervention and the post-intervention periods, respectively. Multivariate analysis showed that SALS was independently associated with favorable neurological outcomes [odds ratio (OR): 2.20; 95% confidence interval (CI): 1.62-2.99]. A total of 2096 patients were propensity score-matched and the two groups were well balanced. In the matched cohort, the use of SALS protocol was still associated with increased prehospital return of spontaneous circulation (ROSC) (OR: 3.83, 95% CI: 2.80-5.26), survival to discharge (OR: 1.68; 95% CI: 1.20-2.34), and favorable neurological outcomes (OR: 1.83; 95% CI: 1.19-2.82).
A multidisciplinary SALS protocol for the resuscitation of patients with OHCA was associated with increased prehospital ROSC, survival to discharge, and good neurologic outcomes compared with traditional resuscitation protocol.
本研究旨在比较实施 Smart Advanced Life Support（SALS）方案前后院外心脏骤停（OHCA）的结局，该方案包括通过实时视频电话改变心肺复苏（CPR）辅助和医生指导。
这是一项在 2014 年 1 月至 2018 年 12 月期间进行的前瞻性、多区域观察性研究。2016 年 1 月，急救医疗服务（EMS）提供者通过 SALS 采用了一种综合的医生通过实时视频电话进行 CPR 指导的方法，用于治疗 OHCA 患者，重点是高质量的心肺复苏。进行了倾向评分匹配以匹配患者。然后将使用常规方案的患者的结果与使用 SALS 方案的患者的结果进行比较。
在 26349 例 OHCA 病例中，分别在干预前和干预后期间纳入了 2351 例和 7261 例患者。多变量分析表明，SALS 与良好的神经功能结局独立相关（优势比[OR]：2.20；95%置信区间[CI]：1.62-2.99）。共对 2096 例患者进行了倾向评分匹配，两组之间平衡良好。在匹配队列中，使用 SALS 方案仍然与院前自主循环恢复（ROSC）增加相关（OR：3.83；95%CI：2.80-5.26）、出院存活率（OR：1.68；95%CI：1.20-2.34）和良好的神经功能结局（OR：1.83；95%CI：1.19-2.82）。
与传统复苏方案相比，针对 OHCA 患者复苏的多学科 SALS 方案与院前 ROSC 增加、出院存活率和良好的神经功能结局相关。
