Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study
Journal
Annals of Emergency Medicine
Journal Volume
71
Journal Issue
5
Pages
608-617.e15
Date Issued
2018
Author(s)
Tanaka H.
Ong M.E.H.
Siddiqui F.J.
Kaneko H.
Lee K.W.
Kajino K.
Lin C.-H.
Gan H.N.
Khruekarnchana P.
Alsakaf O.
Rahman N.H.
Doctor N.E.
Assam P.
Shin S.D.
Sarah A.K.
Julina M.N.
Naroo G.Y.
Alsakaf O.
Yagdir T.
Khunkhlai N.
Monsomboon A.
Piyasuwankul T.
Nishiuchi T.
Kyoung J.S.
Wong K.D.
Mao D.R.H.
Goh E.S.
Tham L.P.
Cheah S.O.
Chia M.Y.C.
Tiah L.
Leong B.S.H.
Ng Y.Y.
PAROS Clinical Research Network
Abstract
Study objective: The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai). Methods: This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community. Results: Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95% CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95% CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95% CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival. Conclusion: In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation. ? 2017 American College of Emergency Physicians
SDGs
Other Subjects
adult; aged; Article; cohort analysis; defibrillation; female; hospital discharge; hospitalization; human; Japan; major clinical study; Malaysia; male; middle aged; multicenter study; out of hospital cardiac arrest; outcome assessment; priority journal; prospective study; respiration control; resuscitation; Singapore; South Korea; survival; Taiwan; Thailand; United Arab Emirates; Asia; clinical trial; emergency health service; epidemiology; mortality; out of hospital cardiac arrest; Pacific islands; procedures; resuscitation; risk assessment; standards; survival analysis; survival rate; very elderly; Aged; Aged, 80 and over; Asia; Cardiopulmonary Resuscitation; Emergency Medical Services; Female; Humans; Male; Middle Aged; Out-of-Hospital Cardiac Arrest; Outcome Assessment (Health Care); Pacific Islands; Prospective Studies; Risk Assessment; Survival Analysis; Survival Rate
Type
journal article