Abstract
Background
High-quality prehospital cardiopulmonary resuscitation (CPR) is important for out-of-hospital
cardiac arrest (OHCA). We aimed to evaluate prehospital CPR quality during scene evacuation
and early ambulance transport in patients with OHCA according to the type of cardiac
arrest location.
Methods
This retrospective observational cohort study enrolled patients with non-traumatic
adult OHCA in Seoul between July 2020 and March 2022. Prehospital CPR quality data
extracted from defibrillators were merged with the national OHCA database. The location
of cardiac arrest was categorized into two groups (residential and non-residential).
CPR quality indices including no-flow (any pause >1.5 s) fraction were compared according
to the type of arrest location at each minute of EMS scene evacuation and early ambulance
transport (5 min prior to 5 min after ambulance departure).
Results
A total of 1,222 OHCAs were enrolled in the final analysis after serial exclusion.
A total of 966 OHCAs (79.1%) occurred in the residential areas. The CPR quality deteriorated
during the scene evacuation in both location type. The mean no-flow fractions were
significantly higher in residential places than in non-residential places. The mean
proportion of adequate compression depth and rate was lower in cardiac arrests in
residential places. The discrepancy in EMS CPR quality during scene evacuation was
more prominent when mechanical CPR devices were not used.
Conclusion
Deterioration of CPR quality was observed just before and during early ambulance transport,
especially when the cardiac arrest location was a residential area or when only manual
CPR was provided.
Keywords
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References
- Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2020; 142: S366-S468
- European Resuscitation Council Guidelines 2021: Basic Life Support.Resuscitation. 2021; 161: 98-114
- High-quality cardiopulmonary resuscitation.Curr Opin Crit Care. 2014; 20: 227-233
- Association between prehospital CPR quality and end-tidal carbon dioxide levels in out-of-hospital cardiac arrest.Prehosp Emerg Care. 2016; 20: 369-377
- Impact of a “Team-focused CPR” protocol on out-of-hospital cardiac arrest survival in a rural EMS system.Crit Pathw Cardiol. 2016; 15: 98-102
- Prehospital CPR training performed with visual feedback.Disaster Emerg Med J. 2018; 3: 41-45
- Out-of-hospital cardiac arrest in high-rise buildings: delays to patient care and effect on survival.CMAJ. 2016; 188: 413-419
- The scene time interval and basic life support termination of resuscitation rule in adult out-of-hospital cardiac arrest.J Korean Med Sci. 2015; 30: 104-109
- Out-of-hospital cardiac arrest without return of spontaneous circulation in the field: Who are the survivors?.Resuscitation. 2017; 112: 28-33
- Neurological outcomes in patients transported to hospital without a prehospital return of spontaneous circulation after cardiac arrest.Crit Care. 2013; 17: 1-10
- Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR): consensus statement of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC.Clin Res Cardiol. 2019; 108: 455-464
- The incidence of “load&go” out-of-hospital cardiac arrest candidates for emergency department utilization of emergency extracorporeal life support: a one-year review.Resuscitation. 2015; 91: 131-136
- To transport or to terminate resuscitation on-site. What factors influence EMS decisions in patients without ROSC? A mixed-methods study.Resuscitation. 2021; 164: 84-92
- Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries.J Formos Med Assoc. 2016; 115: 628-638
- Variation in out-of-hospital cardiac arrest resuscitation and transport practices in the Resuscitation Outcomes Consortium: ROC Epistry-Cardiac Arrest.Resuscitation. 2011; 82: 277-284
- Video-recording and time-motion analyses of manual versus mechanical cardiopulmonary resuscitation during ambulance transport.Resuscitation. 2007; 74: 453-460
- Mechanical versus manual chest compression CPR under ground ambulance transport conditions.Acute Card Care. 2013; 15: 1-6
- Chest compression fraction between mechanical compressions on a reducible stretcher and manual compressions on a standard stretcher during transport in out-of-hospital cardiac arrests: the Ambulance Stretcher Innovation of Asian Cardiopulmonary Resuscitation (ASIA-CPR) pilot trial.Prehosp Emerg Care. 2017; 21: 636-644
- Barriers and facilitators to cardiopulmonary resuscitation within pre-hospital emergency medical services: a qualitative study.BMC Emerg Med. 2021; 21: 1-13
- The “vertical response time”: barriers to ambulance response in an urban area.Acad Emerg Med. 2007; 14: 772-778
- Effect of Dispatcher-Assisted Cardiopulmonary Resuscitation Program and Location of Out-of-Hospital Cardiac Arrest on Survival and Neurologic Outcome.Ann Emerg Med. 2017; 69 (52–61 e1)
- Comparison between dispatcher-assisted bystander CPR and self-led bystander CPR in out-of-hospital cardiac arrest (OHCA).Resuscitation. 2021; 158: 64-70
- Quality of chest compressions during prehospital resuscitation phase from scene arrival to ambulance transport in out-of-hospital cardiac arrest.Resuscitation. 2022; 180: 1-7
- The association between chest compression release velocity and outcomes from out-of-hospital cardiac arrest.Resuscitation. 2015; 86: 38-43
- Chest compression release velocity: association with survival and favorable neurologic outcome after out-of-hospital cardiac arrest.Resuscitation. 2015; 92: 107-114
- Association of intra-arrest transport vs continued on-scene resuscitation with survival to hospital discharge among patients with out-of-hospital cardiac arrest.JAMA. 2020; 324: 1058-1067
- CPR quality during out-of-hospital cardiac arrest transport.Resuscitation. 2017; 114: 34-39
- Manual cardiopulmonary resuscitation versus mechanical cardiopulmonary resuscitation: Which one is more effective during ambulance transport?.Turk J Emerg Med. 2021; 21: 69
- Measuring the EMS patient access time interval andthe impact of responding to high-rise buildings.Prehosp Emerg Care. 2005; 9: 14-18
- Effect of vertical location on survival outcomes for out-of-hospital cardiac arrest in Singapore.Resuscitation. 2019; 139: 24-32
- Quality between mechanical compression on reducible stretcher versus manual compression on standard stretcher in small elevator.Am J Emerg Med. 2016; 34: 1604-1609
- Comparison of chest compression quality between transfer sheet and stretcher use for transporting out-of-hospital cardiac arrest patients in a high-rise building-a randomized and open-label cross-over design.Prehosp Emerg Care. 2021; 25: 370-376
- Association of transport time interval with neurologic outcome in out-of-hospital cardiac arrest patients without return of spontaneous circulation on scene and the interaction effect according to prehospital airway management.Clin Exp Emerg Med. 2022; 9: 93
- EMS agencies with high rates of field termination of resuscitation and longer scene times also have high rates of survival.Resuscitation. 2021; 169: 205-213
Article info
Publication history
Published online: December 27, 2022
Accepted:
December 21,
2022
Received in revised form:
December 21,
2022
Received:
October 25,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
