A retrospective multi-centre cohort study: Pre-hospital survival factors of out-of-hospital cardiac arrest (OHCA) patients in Thailand

• Type of Material: Article
• Authors: Wachiranun Sirikul, Chiang Mai University; Chanodom Piankusol, Chiang Mai University; Borwon Wittayachamnankul, Chiang Mai University; Sattha Riyapan, Siriraj Hospital; Jirapong Supasaovapak, Rajavithi Hospital; Wachira Wongtanasarasin, Chiang Mai University; Bryan McNally, Emory University
• Language: English
• Date: 2022-03-01
• Publisher: Elsevier Inc
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Author(s)
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.resplu.2021.100196
• Title of Journal or Parent Work: Resuscitation Plus
• Volume: 9
• Start Page: 100196
• End Page: 100196
• Grant/Funding Information: This study received USD 30,000 funding from the PAROS organization for data collection facilitation. Rajavithi Hospital, as a country representative, received the $30,000 from PAROS. The funding was distributed to each hospital according to the number of cases collected and entered in the PAROS database as data collection incentives.
• Keywords: Out‐of‐hospital cardiac arrest; CPR, Cardiopulmonary Resuscitation; Response time interval; OHCA, Out‐of‐Hospital Cardiac Arrest; Cardiopulmonary resuscitation; Bystander CPR; Response time; Cardiac arrest; EMS, Emergency Medical Services
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Objective: This study aimed to explore significant pre-hospital factors affecting the survivability of Out-of-Hospital Cardiac Arrest (OHCA) patients in countries with developing EMS systems. Method: A retrospective cohort study was conducted examining data from January 1, 2017 to December 31, 2020 from Utstein Registry databases in Thailand, collected through Pan-Asian Resuscitation Outcomes Study (PAROS). Data were collected from three centres, including regional, suburban-capital, and urban-capital hospitals. The primary endpoint of this study was 30-day survival or discharged alive after an OHCA event. The multivariable risk regression was done by modified Poisson regression with robust error variance to explore the association between 30-day survival and pre-hospital factors with potential confounders adjustments. Findings: Of 1,240 OHCA cases transferred by Emergency Medical Services (EMS), 42 patients (3.4%) were discharged alive after 30 days, including 22 (8.6%), 8 (3.0%), and 12 (1.7%) from regional, suburban-capital, and urban-capital centres, respectively. The initial arrest rhythm was 89.7% unshockable, with no significant variations across the three centres. Overall, bystander Cardiopulmonary Resuscitation (CPR) was 40.4%. However, bystander CPR with Automated External Defibrillator (AED) application was 0.8%. Bystander CPR significantly increased 30-day survival probability (aRR 1.88, 95% CI 1.01 to 3.51; p 0.049). Additionally, reducing the EMS response time by one minute significantly increased OHCA survivability (aRR 1.12, 95% CI 1.04 to 1.20; p 0.001). Conclusions: Response time and bystander CPR are the factors that improve the 30-day survival outcomes of OHCA patients. In contrast, scene time, transport time, and pre-hospital advanced airway management didn't improve 30-day OHCA survival.