Abstract
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.
Keywords
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Article info
Publication history
Published online: April 22, 2021
Accepted:
April 6,
2021
Received in revised form:
January 12,
2021
Received:
November 10,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
