Prevalence of emergency medical service utilisation in patients with out-of-hospital cardiac arrest in Thailand.

BACKGROUND: Most patients with out-of-hospital cardiac arrest (OHCA) have grave outcomes. The efficacy of emergency medical services (EMS) may affect outcomes. However, no data exists in Thailand. OBJECTIVES: To ascertain the prevalence of EMS utilisation in patients with OHCA transferred to Siriraj Hospital and also to elucidate the rates of return of spontaneous circulation (ROSC), hospital admission and survival to hospital discharge. METHODS: This prospective cohort study was conducted in patients with OHCA at a university hospital in Bangkok, Thailand from May 2011 to February 2013. The data was gathered by interviewing bystanders. Data about the mode of transportation, reasons for EMS usage, response time, ROSC and 30-day mortality were collected. Patients with rigour mortis or livor mortis were excluded. The factors affecting ROSC and survival rate were determined by univariate analysis. RESULTS: One hundred and fifty-two patients were included. The prevalence of EMS usage was 14.5% (95% CI 9.3 to 21.0). The most common cause of non-usage of EMS was not knowing or forgetting an EMS number (49.2%). The proportion of bystanders having known an EMS number and using EMS was 34%. The ROSC and 30-day survival rates were 53.3% and 10.5%, respectively. Non-cardiac causes and witnessed arrests were associated with ROSC (p<0.05). CONCLUSIONS: The prevalence of EMS utilisation in OHCA at Siriraj Hospital was very low. This may affect the outcomes of patients with OHCA. Improving the EMS system by publicity to increase public awareness and providing life-support education nationwide may improve outcomes of patients with OHCA in Thailand.

Use of rapid ABG analyzer in measurement of potassium concentration: does it agree with venous potassium concentration?

BACKGROUND: Because extreme venous potassium abnormality can be life threatening, rapid measurement of potassium level is essential. Traditional biochemical analysis for venous potassium takes time and delays management in seriously ill patients. Analysis form arterial blood gas (ABG) may be an alternative method that is faster. OBJECTIVE: To determine agreement between potassium obtained from venous and arterial blood gas in emergency patients, Siriraj Hospital. MATERIAL AND METHOD: Cross-sectional study performed in 53 patients who presented to the emergency department of Siriraj Hospital. Potassium level measured from ABG was compared to venous route. RESULTS: The mean of venous, arterial potassium and difference between each pair were 3.95, 3.46, and 0.49 mmol/L respectively. The Intraclass Correlation Coefficient between each pair of two methods and 95% CI of agreement were 0.904 and 0.839 to 0.943, p < 0.01. CONCLUSION: The agreement between ABG and venous potassium measurement are confirmed Clinicians can use ABG's potassium level as a guideline for treatment instead of using the conventional venous potassium level.