ABSTRACT
Objective@#To investigate variations in the effects of prehospital advanced airway management (AAM) on outcomes of out-of-hospital cardiac arrest (OHCA) patients according to regional emergency medical service (EMS) systems in four Asian cities. @*Methods@#We enrolled adult patients with EMS-treated OHCA of presumed cardiac origin between 2012 and 2014 from Osaka (Japan), Seoul (Republic of Korea), Singapore (Singapore), and Taipei (Taiwan). The main exposure variable was prehospital AAM. The primary endpoint was neurological recovery. We compared outcomes between the prehospital AAM and non-AAM groups using multivariable logistic regression with an interaction term between prehospital AAM and the four Asian cities. @*Results@#A total of 16,510 patients were included in the final analyses. The rates of prehospital AAM varied among Osaka, Seoul, Singapore, and Taipei (65.0%, 19.2%, 84.9%, and 34.1%, respectively). The non-AAM group showed better outcomes than the AAM group (adjusted odds ratio [aOR] for neurological recovery 0.30; 95% confidence interval [CI], 0.24–0.38]). In the interaction model for neurological recovery, the aORs for AAM in Osaka and Singapore were 0.12 (95% CI, 0.06–0.26) and 0.21 (95% CI, 0.16–0.28), respectively. In Seoul and Taipei, the association between prehospital AAM and neurological recovery was not significant (aOR 0.58 [95% CI, 0.31–1.10] and 0.79 [95% CI, 0.52–1.20], respectively). The interaction between prehospital AAM and region was significant (P=0.01). @*Conclusion@#The effects of prehospital AAM on outcomes of OHCA patients differed according to regional variability in the EMS systems.
ABSTRACT
The growth of emergency services in Singapore over years in terms of volume and complexity is relentless. In the pre-hospital environment, ambulance call volumes have more than doubled from 62,095 in 1997 to 142,549 cases in 2012. The use of emergency ambulances services should be commensurate with the timeframe of which the medical condition is deteriorating or the potential for sudden catastrophic outcomes. Activation of the EAS ambulance for STEMIs and strokes help to reduce the D2B time and time to thrombolysis. Patients at risk of AMI or stroke often fail to recognise the symptoms and hence fail to activate the EMS system. Physicians do have a role to identify those at risk to educate them to achieve better outcomes. Good documentation of positive and significant negative findings and relevant tests provides a baseline to expedite patient assessment at the ED. An understanding of the available ED resources as well as the access to services, especially when subspecialty consultation is needed, helps to improve the appropriateness of referrals.
ABSTRACT
The growth of emergency services in Singapore over years in terms of volume and complexity is relentless. In the pre-hospital environment, ambulance call volumes have more than doubled from 62,095 in 1997 to 142,549 cases in 2012. The use of emergency ambulances services should be commensurate with the timeframe of which the medical condition is deteriorating or the potential for sudden catastrophic outcomes. Activation of the EAS ambulance for STEMIs and strokes help to reduce the D2B time and time to thrombolysis. Patients at risk of AMI or stroke often fail to recognise the symptoms and hence fail to activate the EMS system. Physicians do have a role to identify those at risk to educate them to achieve better outcomes. Good documentation of positive and significant negative findings and relevant tests provides a baseline to expedite patient assessment at the ED. An understanding of the available ED resources as well as the access to services, especially when subspecialty consultation is needed, helps to improve the appropriateness of referrals.