Nakamura Atsuo, Odo Masaharu
Department of Emergency and Critical Care Medicine, Iizuka City Hospital, Iizuka, JPN.
Cureus. 2024 Dec 15;16(12):e75736. doi: 10.7759/cureus.75736. eCollection 2024 Dec.
The coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted emergency medical service (EMS) prehospital care for patients with out-of-hospital cardiac arrest (OHCA), necessitating a thorough assessment of its effects on prehospital time and emergency interventions. Therefore, we aimed to analyze the changes in EMS operations before and after the onset of the pandemic and their potential effects on patient care.
We retrospectively reviewed OHCA cases between January 2017 and December 2022, categorizing them into pre-pandemic and pandemic phases. We examined the prehospital time from call intake to hospital arrival, analyzing time segments in detail (on-scene arrival, patient contact, loading, and departure) and procedural frequency/location. Changes in prehospital time, requests for hospital admission, laryngeal tube insertion, and venous line establishment were assessed using a multivariate analysis.
Among the 925 OHCA cases, the pandemic phase (n = 467) experienced a 3-minute average prehospital delay compared with the pre-pandemic phase (n = 458) (P < 0.0001). Specifically, on-scene arrival time (adjusted odds ratio (aOR): 2.06; 95% confidence interval (CI): 1.36-3.11), laryngeal tube insertions (aOR: 3.2; 95% CI: 2.1-4.9), and post-transport venous access placements (aOR: 1.67; 95% CI: 1.06-2.63) increased. Hospital admission requests also increased significantly (aOR: 9.5; 95% CI: 2.78-32.7).
These findings indicate that pandemic conditions delayed EMS responses and altered clinical practices, highlighting the urgent need for EMS system enhancements to improve on-site interventions. Therefore, addressing these challenges, particularly through strategies that expedite early adrenaline administration, is essential for optimizing patient outcomes.
2019年冠状病毒病（COVID-19）大流行严重扰乱了对院外心脏骤停（OHCA）患者的紧急医疗服务（EMS）院前护理，因此有必要全面评估其对院前时间和紧急干预措施的影响。因此，我们旨在分析大流行开始前后EMS运营的变化及其对患者护理的潜在影响。
我们回顾性分析了2017年1月至2022年12月期间的OHCA病例，将其分为大流行前和大流行阶段。我们检查了从呼叫接收到医院到达的院前时间，详细分析了时间片段（现场到达、患者接触、装载和出发）以及程序频率/地点。使用多变量分析评估院前时间、医院入院请求、喉管插入和静脉通路建立的变化。
在925例OHCA病例中，与大流行前阶段（n = 458）相比，大流行阶段（n = 467）的平均院前延迟为3分钟（P < 0.0001）。具体而言，现场到达时间（调整优势比（aOR）：2.06；95%置信区间（CI）：1.36 - 3.11）、喉管插入（aOR：3.2；95% CI：2.1 - 4.9）和转运后静脉通路放置（aOR：1.67；95% CI：1.06 - 2.63）增加。医院入院请求也显著增加（aOR：9.5；95% CI：2.78 - 32.7）。
这些发现表明，大流行状况延迟了EMS响应并改变了临床实践，凸显了迫切需要加强EMS系统以改善现场干预措施。因此，应对这些挑战，特别是通过加快早期肾上腺素给药的策略，对于优化患者预后至关重要。
