J Korean Med Sci.  2015 Jan;30(1):95-103. 10.3346/jkms.2015.30.1.95.

Epidemiology and Outcomes in Out-of-hospital Cardiac Arrest: A Report from the NEDIS-Based Cardiac Arrest Registry in Korea

• Yang HJ
• Kim GW
• Kim H
• Cho JS
• Rho TH
• Yoon HD
• Lee MJ
• The NEDIS-CA Consortium

• KMID: 2155453
• DOI: http://doi.org/10.3346/jkms.2015.30.1.95

Abstract

Sudden cardiac death (SCD) is a significant issue affecting national health policies. The National Emergency Department Information System for Cardiac Arrest (NEDIS-CA) consortium managed a prospective registry of out-of-hospital cardiac arrest (OHCA) at the emergency department (ED) level. We analyzed the NEDIS-CA data from 29 participating hospitals from January 2008 to July 2009. The primary outcomes were incidence of OHCA and final survival outcomes at discharge. Factors influencing survival outcomes were assessed as secondary outcomes. The implementation of advanced emergency management (drugs, endotracheal intubation) and post-cardiac arrest care (therapeutic hypothermia, coronary intervention) was also investigated. A total of 4,156 resuscitation-attempted OHCAs were included, of which 401 (9.6%) patients survived to discharge and 79 (1.9%) were discharged with good neurologic outcomes. During the study period, there were 1,662,470 ED visits in participant hospitals; therefore, the estimated number of resuscitation-attempted CAs was 1 per 400 ED visits (0.25%). Factors improving survival outcomes included younger age, witnessed collapse, onset in a public place, a shockable rhythm in the pre-hospital setting, and applied advanced resuscitation care. We found that active advanced multidisciplinary resuscitation efforts influenced improvement in the survival rate. Resuscitation by public witnesses improved the short-term outcomes (return of spontaneous circulation, survival admission) but did not increase the survival to discharge rate. Strategies are required to reinforce the chain of survival and high-quality cardiopulmonary resuscitation in Korea.

Keyword

Death, Sudden, Cardiac; Resuscitation; Outcome; Cardiac Rhythms; Emergency Department

MeSH Terms

Cardiopulmonary Resuscitation/*mortality
Critical Care/*statistics & numerical data
Death, Sudden, Cardiac/*epidemiology
Electric Countershock/mortality
Emergency Medical Services
Humans
Out-of-Hospital Cardiac Arrest/*epidemiology/*mortality/therapy
Registries
Republic of Korea/epidemiology
Survival Rate
Treatment Outcome

Figure

• 

  Fig. 1 Patient flow according to NEDIS-CA determined on the basis of sudden cardiac death. CA, cardiac arrest; CPC, Cerebral Performance Category; ED, emergency department; NEDIS-CA, National Emergency Department Information System for Cardiac Arrest; OHCA, out-of-hospital cardiac arrest; ROSC, return of spontaneous circulation.

• 

  Fig. 2 Forest plots associated with clinical outcomes in the resuscitation-attempted OHCA group. (A) ROSC (pre-hospital factors), (B) survival to hospital discharge (pre-hospital and in-hospital factors). The odds ratios for survival are significant in age, bystander witnessed, received epinephrine, and initial shockable rhythms. The bystander CPR improved the short-term outcomes (return of spontaneous circulation), but, it did not increase the survival to discharge rate. AED, automated external defibrillation; CPR, cardiopulmonary resuscitation; ED, emergency department; OHCA, out-of-hospital cardiac arrest; PCI, percutaneous coronary intervention; ROSC, return of spontaneous circulation.

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