Association between case volume of ambulance stations and clinical outcomes of out-of-hospital cardiac arrest: A nationwide multilevel analysis.

Autor: Kim KH; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: emphysiciankkh@gmail.com., Ro YS; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: Ro.youngsun@gmail.com., Park JH; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: timthe@gmail.com., Kim TH; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: adoong2001@gmail.com., Jeong J; Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: yukijeje@gmail.com., Hong KJ; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: emkjhong@gmail.com., Song KJ; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: skciva@gmail.com., Shin SD; Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea. Electronic address: sdshin@snu.ac.kr.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2021 Apr 23; Vol. 163, pp. 71-77. Date of Electronic Publication: 2021 Apr 23.
DOI: 10.1016/j.resuscitation.2021.04.014
Abstrakt: Objectives: The case volume effects of ambulance stations on the survival of out-of-hospital cardiac arrest (OHCA) patients are uncertain. This study was conducted to evaluate the association between the case volume of ambulance stations and clinical outcomes in OHCAs by the number of emergency medical services (EMS) providers at the scene.
Methods: Adult cardiac EMS-treated OHCAs between 2015 and 2018 were enrolled. The main exposure was the annual OHCA case volumes of 204 ambulance stations in Korea, which were categorized into three groups; low-volume (<100), moderate-volume (100-159) and high-volume (≥160). The primary and secondary outcomes were good neurological recovery and survival to discharge. Multilevel multivariable logistic regression analysis was conducted to calculate adjusted odds ratios (AORs). Interaction analysis between the number of EMS providers at the scene and the exposure variable was performed.
Results: A total of 92,534 patients were enrolled. OHCAs in the low-volume group tended to be arrest in a public place or a non-metropolitan area, less prehospital administration of an advanced airway and intravenous management. Significant differences were found the main analysis: AORs (95% CIs) compared to the low-volume group were 1.15 (1.03-1.29) and 1.14 (1.03-1.27) in the high-volume and moderate-volume groups for good neurological recovery and 1.19 (1.07-1.33) and 1.14 (1.04-1.25) in the high-volume and moderate-volume groups for survival to discharge. Significant interaction effects between the number of EMS providers at the scene and case volume on clinical outcomes were found.
Conclusion: OHCA case volumes of ambulance stations are associated with clinical outcomes after cardiac arrest.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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