Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries
Journal
Journal of the Formosan Medical Association
Journal Volume
115
Journal Issue
8
Pages
628-638
Date Issued
2016
Author(s)
Lin C.-H.
Ng Y.Y.
Karim S.A.
Shin S.D.
Tanaka H.
Nishiuchi T.
Kajino K.
Khunkhlai N.
Ong M.E.H.
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. © 2015
Other Subjects
Article; Asia; clinical assessment; clinical protocol; do not resuscitate; emergency care; emergency health service; emergency physician; external defibrillator; health care policy; health care system; human; Japan; Malaysia; medical director; multicenter study; out of hospital cardiac arrest; patient transport; qualitative analysis; resuscitation; Singapore; South Korea; Taiwan; termination of resuscitation; Thailand; Asia; city; clinical protocol; cost benefit analysis; defibrillator; emergency health service; Out-of-Hospital Cardiac Arrest; physician; questionnaire; resuscitation; standards; Asia; Cardiopulmonary Resuscitation; Cities; Clinical Protocols; Cost-Benefit Analysis; Defibrillators; Emergency Medical Services; Humans; Out-of-Hospital Cardiac Arrest; Physicians; Resuscitation Orders; Surveys and Questionnaires
Type
journal article