Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries

Chih Hao Lin, Yih Yng Ng, Wen Chu Chiang, Sarah Abdul Karim, Sang Do Shin, Hideharu Tanaka, Tatsuya Nishiuchi, Kentaro Kajino, Nalinas Khunkhlai, Matthew Huei Ming Ma, Marcus Eng Hock Ong

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background/Purpose Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. Methods A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. Results Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5%) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5%) cities performed 4 minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR. Conclusion International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.

Original languageEnglish
Pages (from-to)628-638
Number of pages11
JournalJournal of the Formosan Medical Association
Volume115
Issue number8
DOIs
Publication statusPublished - 2016 Aug 1

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Out-of-Hospital Cardiac Arrest
Resuscitation
Emergency Medical Services
Defibrillators
Cardiopulmonary Resuscitation
Consensus
Transportation of Patients
Resuscitation Orders
Physician Executives
Police
Medical Education
Administrative Personnel
Cost-Benefit Analysis
Emergencies
Physicians

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Lin, Chih Hao ; Ng, Yih Yng ; Chiang, Wen Chu ; Karim, Sarah Abdul ; Shin, Sang Do ; Tanaka, Hideharu ; Nishiuchi, Tatsuya ; Kajino, Kentaro ; Khunkhlai, Nalinas ; Ma, Matthew Huei Ming ; Ong, Marcus Eng Hock. / Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries. In: Journal of the Formosan Medical Association. 2016 ; Vol. 115, No. 8. pp. 628-638.
@article{a93b54b4073a433195a9f7828383ea91,
title = "Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries",
abstract = "Background/Purpose Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. Methods A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. Results Responses were obtained from eight cities in six Asian countries. Only one (12.5{\%}) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5{\%}) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5{\%}) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50{\%}) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5{\%}) cities performed 4 minutes of on-scene CPR; one (12.5{\%}) city allowed variation in the duration of on-scene CPR. Conclusion International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.",
author = "Lin, {Chih Hao} and Ng, {Yih Yng} and Chiang, {Wen Chu} and Karim, {Sarah Abdul} and Shin, {Sang Do} and Hideharu Tanaka and Tatsuya Nishiuchi and Kentaro Kajino and Nalinas Khunkhlai and Ma, {Matthew Huei Ming} and Ong, {Marcus Eng Hock}",
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Lin, CH, Ng, YY, Chiang, WC, Karim, SA, Shin, SD, Tanaka, H, Nishiuchi, T, Kajino, K, Khunkhlai, N, Ma, MHM & Ong, MEH 2016, 'Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries', Journal of the Formosan Medical Association, vol. 115, no. 8, pp. 628-638. https://doi.org/10.1016/j.jfma.2015.10.003

Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries. / Lin, Chih Hao; Ng, Yih Yng; Chiang, Wen Chu; Karim, Sarah Abdul; Shin, Sang Do; Tanaka, Hideharu; Nishiuchi, Tatsuya; Kajino, Kentaro; Khunkhlai, Nalinas; Ma, Matthew Huei Ming; Ong, Marcus Eng Hock.

In: Journal of the Formosan Medical Association, Vol. 115, No. 8, 01.08.2016, p. 628-638.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries

AU - Lin, Chih Hao

AU - Ng, Yih Yng

AU - Chiang, Wen Chu

AU - Karim, Sarah Abdul

AU - Shin, Sang Do

AU - Tanaka, Hideharu

AU - Nishiuchi, Tatsuya

AU - Kajino, Kentaro

AU - Khunkhlai, Nalinas

AU - Ma, Matthew Huei Ming

AU - Ong, Marcus Eng Hock

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background/Purpose Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. Methods A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. Results Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5%) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5%) cities performed 4 minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR. Conclusion International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.

AB - Background/Purpose Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. Methods A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. Results Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5%) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5%) cities performed 4 minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR. Conclusion International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.

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