Outcomes from out-of-hospital cardiac arrest in Metropolitan Taipei: Does an advanced life support service make a difference?

Matthew Huei Ming Ma, Wen Chu Chiang, Patrick Chow In Ko, Jimmy Ching Chih Huang, Chih-Hao Lin, Hui Chi Wang, Wei Tien Chang, Chien Hwa Hwang, Yao Cheng Wang, Guan Hwa Hsiung, Bin Chou Lee, Shyr Chyr Chen, Wen Jone Chen, Fang Yue Lin

研究成果: Article

64 引文 (Scopus)

摘要

Background: Out-of-hospital cardiac arrest (OHCA) is of major medical and public health significance. It also serves as a good indicator in assessing the performance of local emergency medical services system (EMS). There have been arguments for and against the benefits of advanced life support (ALS) over basic life support with defibrillator (BLS-D) for treating OHCA. Aims of the study: The study was conducted to characterise the outcomes of cardiac arrest victims in an Asian metropolitan city; to evaluate the impacts of ALS versus BLS-D services; and to explore the possible patient and arrest factors that may be associated with the observed differences in the outcomes between the two pre-hospital care models. Materials and methods: Taipei is an Asian metropolitan city with an area of 272 km2 and a population of 2.65 million. The fire-based BLS-D EMS system was in the process of phasing in ALS capability. While there were 40 BLS-D teams in the 12 city districts, two ALS teams were set up in the central part of the city. In this prospective study, all adult non-traumatic OHCA from September 2003 to August 2004 were included. Patient, arrest, care, and outcome variables for OHCA victims were collected from prehospital run sheets, automatic defibrillators, and emergency department and hospital records. Results: Among 1423 OHCA included in the analysis, 1037 (73%) received BLS-D service, and 386 (27%) received ALS services. The initial shockable rhythms and early bystander CPR were strongly associated with better survival for victims of cardiac arrests. Compared to BLS-D, ALS patients had similar age, sex, witness status, the rate of bystander CPR, and response timeliness but more patients in asystole (84% versus 72%, p = 0.005). Patients treated by ALS were more likely to result in significantly higher rates of return of spontaneous circulation (29% versus 21%; OR = 1.51 (95% CI 1.15-2.00); p = 0.002) and survival to emergency department/intensive care unit admission (23% versus 15%; OR = 1.66 (95% CI 1.22-2.24); p = 0.001), but there was no difference in the rate of survival to hospital discharge (7% versus 5%; OR = 1.39 (95% CI 0.84-2.23); p = 0.17). The outcome difference from ALS services was more pronounced among patients in asystole and without bystander CPR. Conclusions: In this metropolitan EMS in Asia, the implementation of ALS services improved the intermediate, but not the final outcomes. Communities with larger populations and lower incidence of initial shockable rhythms than the OPALS study should also prioritise their resources in setting up and optimising systems of basic life support and early defibrillations. Further studies are warranted to configure the optimal care model for combating cardiac arrest.

原文English
頁(從 - 到)461-469
頁數9
期刊Resuscitation
74
發行號3
DOIs
出版狀態Published - 2007 九月 1

指紋

Out-of-Hospital Cardiac Arrest
Defibrillators
Heart Arrest
Cardiopulmonary Resuscitation
Emergency Medical Services
Hospital Emergency Service
Life Support Systems
Urbanization
Survival
Hospital Records

All Science Journal Classification (ASJC) codes

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

引用此文

Ma, Matthew Huei Ming ; Chiang, Wen Chu ; Ko, Patrick Chow In ; Huang, Jimmy Ching Chih ; Lin, Chih-Hao ; Wang, Hui Chi ; Chang, Wei Tien ; Hwang, Chien Hwa ; Wang, Yao Cheng ; Hsiung, Guan Hwa ; Lee, Bin Chou ; Chen, Shyr Chyr ; Chen, Wen Jone ; Lin, Fang Yue. / Outcomes from out-of-hospital cardiac arrest in Metropolitan Taipei : Does an advanced life support service make a difference?. 於: Resuscitation. 2007 ; 卷 74, 編號 3. 頁 461-469.
@article{c31fd5b29f4b4d0c8839a565d09b7c44,
title = "Outcomes from out-of-hospital cardiac arrest in Metropolitan Taipei: Does an advanced life support service make a difference?",
abstract = "Background: Out-of-hospital cardiac arrest (OHCA) is of major medical and public health significance. It also serves as a good indicator in assessing the performance of local emergency medical services system (EMS). There have been arguments for and against the benefits of advanced life support (ALS) over basic life support with defibrillator (BLS-D) for treating OHCA. Aims of the study: The study was conducted to characterise the outcomes of cardiac arrest victims in an Asian metropolitan city; to evaluate the impacts of ALS versus BLS-D services; and to explore the possible patient and arrest factors that may be associated with the observed differences in the outcomes between the two pre-hospital care models. Materials and methods: Taipei is an Asian metropolitan city with an area of 272 km2 and a population of 2.65 million. The fire-based BLS-D EMS system was in the process of phasing in ALS capability. While there were 40 BLS-D teams in the 12 city districts, two ALS teams were set up in the central part of the city. In this prospective study, all adult non-traumatic OHCA from September 2003 to August 2004 were included. Patient, arrest, care, and outcome variables for OHCA victims were collected from prehospital run sheets, automatic defibrillators, and emergency department and hospital records. Results: Among 1423 OHCA included in the analysis, 1037 (73{\%}) received BLS-D service, and 386 (27{\%}) received ALS services. The initial shockable rhythms and early bystander CPR were strongly associated with better survival for victims of cardiac arrests. Compared to BLS-D, ALS patients had similar age, sex, witness status, the rate of bystander CPR, and response timeliness but more patients in asystole (84{\%} versus 72{\%}, p = 0.005). Patients treated by ALS were more likely to result in significantly higher rates of return of spontaneous circulation (29{\%} versus 21{\%}; OR = 1.51 (95{\%} CI 1.15-2.00); p = 0.002) and survival to emergency department/intensive care unit admission (23{\%} versus 15{\%}; OR = 1.66 (95{\%} CI 1.22-2.24); p = 0.001), but there was no difference in the rate of survival to hospital discharge (7{\%} versus 5{\%}; OR = 1.39 (95{\%} CI 0.84-2.23); p = 0.17). The outcome difference from ALS services was more pronounced among patients in asystole and without bystander CPR. Conclusions: In this metropolitan EMS in Asia, the implementation of ALS services improved the intermediate, but not the final outcomes. Communities with larger populations and lower incidence of initial shockable rhythms than the OPALS study should also prioritise their resources in setting up and optimising systems of basic life support and early defibrillations. Further studies are warranted to configure the optimal care model for combating cardiac arrest.",
author = "Ma, {Matthew Huei Ming} and Chiang, {Wen Chu} and Ko, {Patrick Chow In} and Huang, {Jimmy Ching Chih} and Chih-Hao Lin and Wang, {Hui Chi} and Chang, {Wei Tien} and Hwang, {Chien Hwa} and Wang, {Yao Cheng} and Hsiung, {Guan Hwa} and Lee, {Bin Chou} and Chen, {Shyr Chyr} and Chen, {Wen Jone} and Lin, {Fang Yue}",
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doi = "10.1016/j.resuscitation.2007.02.006",
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Ma, MHM, Chiang, WC, Ko, PCI, Huang, JCC, Lin, C-H, Wang, HC, Chang, WT, Hwang, CH, Wang, YC, Hsiung, GH, Lee, BC, Chen, SC, Chen, WJ & Lin, FY 2007, 'Outcomes from out-of-hospital cardiac arrest in Metropolitan Taipei: Does an advanced life support service make a difference?', Resuscitation, 卷 74, 編號 3, 頁 461-469. https://doi.org/10.1016/j.resuscitation.2007.02.006

Outcomes from out-of-hospital cardiac arrest in Metropolitan Taipei : Does an advanced life support service make a difference? / Ma, Matthew Huei Ming; Chiang, Wen Chu; Ko, Patrick Chow In; Huang, Jimmy Ching Chih; Lin, Chih-Hao; Wang, Hui Chi; Chang, Wei Tien; Hwang, Chien Hwa; Wang, Yao Cheng; Hsiung, Guan Hwa; Lee, Bin Chou; Chen, Shyr Chyr; Chen, Wen Jone; Lin, Fang Yue.

於: Resuscitation, 卷 74, 編號 3, 01.09.2007, p. 461-469.

研究成果: Article

TY - JOUR

T1 - Outcomes from out-of-hospital cardiac arrest in Metropolitan Taipei

T2 - Does an advanced life support service make a difference?

AU - Ma, Matthew Huei Ming

AU - Chiang, Wen Chu

AU - Ko, Patrick Chow In

AU - Huang, Jimmy Ching Chih

AU - Lin, Chih-Hao

AU - Wang, Hui Chi

AU - Chang, Wei Tien

AU - Hwang, Chien Hwa

AU - Wang, Yao Cheng

AU - Hsiung, Guan Hwa

AU - Lee, Bin Chou

AU - Chen, Shyr Chyr

AU - Chen, Wen Jone

AU - Lin, Fang Yue

PY - 2007/9/1

Y1 - 2007/9/1

N2 - Background: Out-of-hospital cardiac arrest (OHCA) is of major medical and public health significance. It also serves as a good indicator in assessing the performance of local emergency medical services system (EMS). There have been arguments for and against the benefits of advanced life support (ALS) over basic life support with defibrillator (BLS-D) for treating OHCA. Aims of the study: The study was conducted to characterise the outcomes of cardiac arrest victims in an Asian metropolitan city; to evaluate the impacts of ALS versus BLS-D services; and to explore the possible patient and arrest factors that may be associated with the observed differences in the outcomes between the two pre-hospital care models. Materials and methods: Taipei is an Asian metropolitan city with an area of 272 km2 and a population of 2.65 million. The fire-based BLS-D EMS system was in the process of phasing in ALS capability. While there were 40 BLS-D teams in the 12 city districts, two ALS teams were set up in the central part of the city. In this prospective study, all adult non-traumatic OHCA from September 2003 to August 2004 were included. Patient, arrest, care, and outcome variables for OHCA victims were collected from prehospital run sheets, automatic defibrillators, and emergency department and hospital records. Results: Among 1423 OHCA included in the analysis, 1037 (73%) received BLS-D service, and 386 (27%) received ALS services. The initial shockable rhythms and early bystander CPR were strongly associated with better survival for victims of cardiac arrests. Compared to BLS-D, ALS patients had similar age, sex, witness status, the rate of bystander CPR, and response timeliness but more patients in asystole (84% versus 72%, p = 0.005). Patients treated by ALS were more likely to result in significantly higher rates of return of spontaneous circulation (29% versus 21%; OR = 1.51 (95% CI 1.15-2.00); p = 0.002) and survival to emergency department/intensive care unit admission (23% versus 15%; OR = 1.66 (95% CI 1.22-2.24); p = 0.001), but there was no difference in the rate of survival to hospital discharge (7% versus 5%; OR = 1.39 (95% CI 0.84-2.23); p = 0.17). The outcome difference from ALS services was more pronounced among patients in asystole and without bystander CPR. Conclusions: In this metropolitan EMS in Asia, the implementation of ALS services improved the intermediate, but not the final outcomes. Communities with larger populations and lower incidence of initial shockable rhythms than the OPALS study should also prioritise their resources in setting up and optimising systems of basic life support and early defibrillations. Further studies are warranted to configure the optimal care model for combating cardiac arrest.

AB - Background: Out-of-hospital cardiac arrest (OHCA) is of major medical and public health significance. It also serves as a good indicator in assessing the performance of local emergency medical services system (EMS). There have been arguments for and against the benefits of advanced life support (ALS) over basic life support with defibrillator (BLS-D) for treating OHCA. Aims of the study: The study was conducted to characterise the outcomes of cardiac arrest victims in an Asian metropolitan city; to evaluate the impacts of ALS versus BLS-D services; and to explore the possible patient and arrest factors that may be associated with the observed differences in the outcomes between the two pre-hospital care models. Materials and methods: Taipei is an Asian metropolitan city with an area of 272 km2 and a population of 2.65 million. The fire-based BLS-D EMS system was in the process of phasing in ALS capability. While there were 40 BLS-D teams in the 12 city districts, two ALS teams were set up in the central part of the city. In this prospective study, all adult non-traumatic OHCA from September 2003 to August 2004 were included. Patient, arrest, care, and outcome variables for OHCA victims were collected from prehospital run sheets, automatic defibrillators, and emergency department and hospital records. Results: Among 1423 OHCA included in the analysis, 1037 (73%) received BLS-D service, and 386 (27%) received ALS services. The initial shockable rhythms and early bystander CPR were strongly associated with better survival for victims of cardiac arrests. Compared to BLS-D, ALS patients had similar age, sex, witness status, the rate of bystander CPR, and response timeliness but more patients in asystole (84% versus 72%, p = 0.005). Patients treated by ALS were more likely to result in significantly higher rates of return of spontaneous circulation (29% versus 21%; OR = 1.51 (95% CI 1.15-2.00); p = 0.002) and survival to emergency department/intensive care unit admission (23% versus 15%; OR = 1.66 (95% CI 1.22-2.24); p = 0.001), but there was no difference in the rate of survival to hospital discharge (7% versus 5%; OR = 1.39 (95% CI 0.84-2.23); p = 0.17). The outcome difference from ALS services was more pronounced among patients in asystole and without bystander CPR. Conclusions: In this metropolitan EMS in Asia, the implementation of ALS services improved the intermediate, but not the final outcomes. Communities with larger populations and lower incidence of initial shockable rhythms than the OPALS study should also prioritise their resources in setting up and optimising systems of basic life support and early defibrillations. Further studies are warranted to configure the optimal care model for combating cardiac arrest.

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