Lee Ju Heon, Kim Hyung Il
Department of Emergency Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.
J Trauma Inj. 2023 Sep;36(3):172-179. doi: 10.20408/jti.2023.0009. Epub 2023 Aug 2.
Out-of-hospital traumatic cardiac arrest (TCA) often has a poor prognosis despite rescue efforts. Although the incidence and mortality of out-of-hospital cardiac arrest have increased, bystander cardiopulmonary resuscitation (CPR) has decreased in some countries during the COVID-19 pandemic. In the prehospital setting, immediate treatment of cardiac arrest is required without knowing the patient's COVID-19 status. Because COVID-19 is usually transmitted through the respiratory tract, airway management can put medical personnel at risk for infection. This study explored whether on-scene treatments involving CPR for TCA patients changed during the COVID-19 pandemic in Korea.
This retrospective study used data from emergency medical services (EMS) run sheets in Gangwon Province from January 2019 to December 2021. Patients whose initial problem was cardiac arrest and who received CPR were included. Data in 2019 were classified as pre-COVID-19 and all subsequent data (from 2020 and 2021) as post-COVID-19. Age, sex, possible cause of cardiac arrest, and treatments including airway maneuvers, oropharyngeal airway (OPA) or i-gel insertion, endotracheal intubation (ETI), bag-valve mask (BVM) ventilation, intravenous (IV) line establishment, neck collar application, and wound dressing with hemostasis were investigated.
During the study period, 2,007 patients received CPR, of whom 596 patients had TCA and 367 had disease-origin cardiac arrest (DCA). Among the patients with TCA, 192 (32.2%) were pre-COVID-19 and 404 (67.8%) were post-COVID-19. In the TCA group, prehospital treatments did not decrease. The average frequencies were 59.7% for airway maneuvers, 47.5% for OPA, 57.4% for BVM, and 51.3% for neck collar application. The rates of ETI, i-gel insertion, and IV-line establishment increased. The treatment rate for TCA was significantly higher than that for DCA.
Prehospital treatments by EMS workers for patients with TCA did not decrease during the COVID-19 pandemic. Instead, the rates of ETI, i-gel insertion, and IV-line establishment increased.
尽管进行了抢救，但院外创伤性心脏骤停（TCA）的预后通常较差。虽然院外心脏骤停的发病率和死亡率有所上升，但在新冠疫情期间，一些国家旁观者心肺复苏（CPR）的实施率却有所下降。在院前环境中，在不了解患者新冠病毒感染状况的情况下，需要立即对心脏骤停进行治疗。由于新冠病毒通常通过呼吸道传播，气道管理可能会使医护人员面临感染风险。本研究探讨了在韩国新冠疫情期间，针对TCA患者进行心肺复苏的现场治疗是否发生了变化。
这项回顾性研究使用了2019年1月至2021年12月江原道紧急医疗服务（EMS）运行记录的数据。纳入初始问题为心脏骤停且接受了心肺复苏的患者。2019年的数据归类为新冠疫情前，所有后续数据（2020年和2021年）归类为新冠疫情后。调查了年龄、性别、心脏骤停的可能原因以及包括气道操作、口咽气道（OPA）插入或i-gel插入、气管插管（ETI）、袋阀面罩（BVM）通气、建立静脉（IV）通路、应用颈托以及伤口止血包扎等治疗措施。
在研究期间，2007例患者接受了心肺复苏，其中596例为TCA患者，367例为疾病源性心脏骤停（DCA）患者。在TCA患者中，192例（32.2%）为新冠疫情前患者，404例（67.8%）为新冠疫情后患者。在TCA组中，院前治疗并未减少。气道操作的平均频率为59.7%，OPA插入为47.5%，BVM通气为57.4%，应用颈托为51.3%。ETI、i-gel插入和建立静脉通路的比例有所增加。TCA的治疗率显著高于DCA。
在新冠疫情期间，EMS工作人员对TCA患者的院前治疗并未减少。相反，ETI、i-gel插入和建立静脉通路的比例有所增加。
