Variability in the effects of prehospital advanced airway management on outcomes of patients with out-of-hospital cardiac arrest

Variability in the effects of prehospital advanced airway management on outcomes of patients with out-of-hospital cardiac arrest

OBJECTIVETo investigate variations in the effects of prehospital advanced airway management (AAM) on outcomes of out-of-hospital cardiac arrest (OHCA) patients according to regional emergency medical service (EMS) systems in four Asian cities. METHODSWe enrolled adult patients with EMS-treated OHCA...

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Published in:Clinical and experimental emergency medicine Vol. 7; no. 2; pp. 95 - 106
Main Authors: Oh, Young Seok, Ahn, Ki Ok, Shin, Sang Do, Kagino, Kentaro, Nishiuchi, Tatsuya, Ma, Matthew, Ko, Patrick, Ong, Marcus Eng Hock, Yng, Ng Yih, Leong, Benjamin
Format: Journal Article
Language:English
Published: The Korean Society of Emergency Medicine 01-06-2020
대한응급의학회
Subjects:
airway management
emergency medical services
Original
out-of-hospital cardiac arrest
응급의학
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Summary:OBJECTIVETo investigate variations in the effects of prehospital advanced airway management (AAM) on outcomes of out-of-hospital cardiac arrest (OHCA) patients according to regional emergency medical service (EMS) systems in four Asian cities. METHODSWe enrolled adult patients with EMS-treated OHCA of presumed cardiac origin between 2012 and 2014 from Osaka (Japan), Seoul (Republic of Korea), Singapore (Singapore), and Taipei (Taiwan). The main exposure variable was prehospital AAM. The primary endpoint was neurological recovery. We compared outcomes between the prehospital AAM and non-AAM groups using multivariable logistic regression with an interaction term between prehospital AAM and the four Asian cities. RESULTSA total of 16,510 patients were included in the final analyses. The rates of prehospital AAM varied among Osaka, Seoul, Singapore, and Taipei (65.0%, 19.2%, 84.9%, and 34.1%, respectively). The non-AAM group showed better outcomes than the AAM group (adjusted odds ratio [aOR] for neurological recovery 0.30; 95% confidence interval [CI], 0.24-0.38]). In the interaction model for neurological recovery, the aORs for AAM in Osaka and Singapore were 0.12 (95% CI, 0.06-0.26) and 0.21 (95% CI, 0.16-0.28), respectively. In Seoul and Taipei, the association between prehospital AAM and neurological recovery was not significant (aOR 0.58 [95% CI, 0.31-1.10] and 0.79 [95% CI, 0.52-1.20], respectively). The interaction between prehospital AAM and region was significant (P=0.01). CONCLUSIONThe effects of prehospital AAM on outcomes of OHCA patients differed according to regional variability in the EMS systems.
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https://www.ceemjournal.org/journal/view.php?number=276
ISSN:2383-4625
2383-4625
DOI:10.15441/ceem.19.022