Features of hospital and emergency medical service in out-of-hospital cardiac arrest patients with shockable rhythm.
OBJECTIVE
Predicting the outcome of out-of-hospital cardiac arrest (OHCA) patients is crucial. We examined hospital characteristics and parameters of emergency medical service (including scene time interval and direct ambulance delivery to intensive heart hospitals) as survival or outcome predictors.


METHODS
Data from 546 consecutive OHCA shockable patients treated between January 2012 and December 2015 in Taoyuan City (Taiwan, ROC) were collected. In addition to demographic data, location of arrest, initial rhythm, availability of a hospital with or without 24/7 percutaneous coronary intervention (PCI), emergency medical service (EMS) time, provision of cardiopulmonary resuscitation by a bystander, presence of a witness at collapse, and level of life support were analysed.


RESULTS
Multivariate analysis showed that hospitalisation with immediate PCI availability was an independent predictor (OR: 4.32; 95% CI: 1.27-14.70) solely for the outcome of survival until discharge. The presence of a witness while collapsing (OR: 3.52; 95% CI: 1.03-11.98), EMS response time (OR: 0.83; 95% CI: 0.70-0.98), and scene time interval (STI; OR: 0.89; 95% CI: 0.81-0.99) were valuable for predicting the neurological outcome.


CONCLUSIONS
Direct ambulance delivery to intensive heart hospitals that had 24/7 PCI availability was associated with a higher probability of surviving until discharge in OHCA patients with shockable rhythms. Similarly, a witnessed collapse was correlated with being discharged alive from hospital and recovering with good cerebral performance. In addition, longer response time and scene time interval indicated poorer survival and neurological outcome.
Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan.
Shang-Li
SL
Tsai
Chang Gung University College of Medicine, 259 Wen-Hwa 1st Road, Guishan District, Taoyuan 333, Taiwan; Department of Emergency Medicine and Medical Education, Taipei Chang Gung Memorial Hospital, 199 Tunghwa Road, Taipei 105, Taiwan.
Chung-Hsien
CH
Chaou
Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Anle District, Keelung 204, Taiwan.
Chien-Hsiung
CH
Huang
Institute of Epidemiology and Preventive Medicine, National Taiwan University, Room 501, 17 Xu-Zhou Road, Taipei 100, Taiwan.
I-Shiang
IS
Tzeng
Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan.
Chan-Wei
CW
Kuo
Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan.
Yi-Ming
YM
Weng
Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan; Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Anle District, Keelung 204, Taiwan. Electronic address: rainccy217@gmail.com.
Cheng-Yu
CY
Chien
D000368:Aged; D000552:Ambulances; D016887:Cardiopulmonary Resuscitation; D004554:Electric Countershock; D004632:Emergency Medical Services; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012189:Retrospective Studies; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
Cardiopulmonary resuscitation; Cerebral performance; Defibrillation; Out-of-hospital cardiac arrest; Scene time interval