National Fire Agency, Sejong, Korea.
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
Prehosp Emerg Care. 2023;27(6):736-743. doi: 10.1080/10903127.2022.2099601. Epub 2022 Jul 29.
This study aimed to investigate the effects of adding advanced cardiac life support (ACLS) training to an existing basic life support program and the operation of a designated team response for patients with out-of-hospital cardiac arrest (OHCA) on prehospital return of spontaneous circulation (ROSC) and ACLS management.
A natural experimental study was conducted for emergency medical service (EMS)-treated adult patients with OHCA in 2020. In 2019, a quarter of the EMS clinicians were trained in a 3-day ACLS courses, and they were designated to be dispatched first in suspected OHCA. Some were dispatched only to major emergencies, such as OHCA and myocardial infarction (dedicated team), while others were dispatched to all emergencies with priority to major ones (non-dedicated team). The exposure was the ambulance response type: dedicated, non-dedicated, and basic teams (others). The primary outcome was prehospital ROSC. The secondary outcomes were prehospital ACLS (advanced airway management and intravenous access). A multivariable logistic regression analysis was conducted to investigate the effect of ambulance response type on study outcomes.
Among 23,512 eligible patients with OHCA, 54.8% (12,874) were treated by the basic team, 36.5% (8,580) by the non-dedicated ACLS team, and 8.8% (2,058) were treated by the dedicated ACLS team. Prehospital ROSC was greater for the designated team than for the basic team (dedicated ACLS team 13.8%, non-dedicated ACLS team 11.3%, and basic team 6.7%) (p < 0.01). In the final logistic regression analysis, compared with the basic team, the designated ACLS team was associated with a higher probability of prehospital ROSC (AOR (95% CIs), 1.88 (1.68-2.09) compared to the non-dedicated ACLS team, and 2.46 (2.09-2.90) compared to the dedicated ACLS team), prehospital advanced airway management (1.72 (1.57-1.87) and 1.73 (1.48-2.03), respectively), and intravenous access (2.29 (2.16-2.43) and 2.76 (2.50-3.04), respectively).
Additional ACLS training and operation of a designated OHCA team response were associated with higher rates of prehospital ROSC and prehospital ACLS provision. However, further research is needed to find the optimal operation for EMS to improve survival outcomes.
本研究旨在探讨在现有的基础生命支持（BLS）项目中增加高级心脏生命支持（ACLS）培训以及为院外心脏骤停（OHCA）患者指定团队响应对院前自主循环（ROSC）和 ACLS 管理的影响。
对 2020 年接受急救医疗服务（EMS）治疗的成年 OHCA 患者进行了自然实验研究。2019 年，四分之一的 EMS 临床医生接受了为期 3 天的 ACLS 课程培训，并被指定为疑似 OHCA 的首批派遣人员。一些人仅被派遣处理主要紧急情况，如 OHCA 和心肌梗死（指定团队），而另一些人则被派遣处理所有紧急情况（非指定团队），但优先处理主要紧急情况。暴露因素是救护车反应类型：指定、非指定和基本团队（其他）。主要结局是院前 ROSC。次要结局是院前 ACLS（高级气道管理和静脉通路）。采用多变量逻辑回归分析来研究救护车反应类型对研究结果的影响。
在 23512 名符合条件的 OHCA 患者中，54.8%（12874 人）由基础团队治疗，36.5%（8580 人）由非指定 ACLS 团队治疗，8.8%（2058 人）由指定 ACLS 团队治疗。指定团队的院前 ROSC 大于基础团队（指定 ACLS 团队 13.8%，非指定 ACLS 团队 11.3%，基础团队 6.7%）（p<0.01）。在最终的逻辑回归分析中，与基础团队相比，指定 ACLS 团队与更高的院前 ROSC 概率相关（AOR（95%CI），1.88（1.68-2.09）与非指定 ACLS 团队相比，和 2.46（2.09-2.90）与指定 ACLS 团队相比），院前高级气道管理（1.72（1.57-1.87）和 1.73（1.48-2.03））和静脉通路（2.29（2.16-2.43）和 2.76（2.50-3.04））。
额外的 ACLS 培训和指定的 OHCA 团队响应的操作与更高的院前 ROSC 和院前 ACLS 提供率相关。然而，需要进一步的研究来找到改善 EMS 生存结果的最佳操作方法。
