J Korean Soc Emerg Med.  2016 Apr;27(2):165-172. 10.0000/jksem.2016.27.2.165.

The Factors Influencing Neurological Outcome of Out-of-hospital Cardiac Arrest with Cardiac Etiology

• Jeong SY
• Kim CW
• Yoon TH
• Kim YJ
• Hong SO
• Choi JA

• KMID: 2164246
• DOI: http://doi.org/10.0000/jksem.2016.27.2.165

Abstract

PURPOSE
The purpose of this study is to examine the factors associated with neurological outcome and to provide ideas for improving the operation of the emergency medical system in Korea.
METHODS
A total of 95,911 out-of-hospital cardiac arrests (OHCAs) with cardiac etiology who were transported by 119 EMS ambulances for seven years from 2006 to 2012 in Korea were analyzed. According to these data there is a multilevel structure, so that patient's neurological outcome in the same region is not independent but interrelated, therefore two-level (patient-region) logistic regression analysis was applied to adjust this correlation.
RESULTS
The adjusted odds ratio (OR) in the group in which Cardiopulmonary Resuscitation (CPR) was performed by a bystander was 1.27 for good neurological outcome. The adjusted OR in the group with implementation of an automated external defibrillator (AED) before arrival at the hospital was 4.11 for good neurological outcome. The adjusted OR in the numbers of emergency physicians compared with <3 was 2.76 (3-4), 4.24 (≥5) and the adjusted OR in OHCAs volume of each hospital compared with <50 was 2.31 (50-64), 2.51 (65-102), and 2.94 (≥103). The adjusted OR in deprivation level compared with <2 was 0.72 (≥2).
CONCLUSION
The neurological outcome was significantly better in the group in which CPR was performed by a bystander and AED was applied early. The neurological outcome tended to be significantly better in hospitals with higher numbers of emergency physicians and higher volume of OHCAs, in less deprived districts.

Keyword

Multilevel analysis; Out-of-hospital Cardiac Arrest; Neurological outcome; Korea

MeSH Terms

Ambulances
Cardiopulmonary Resuscitation
Defibrillators
Emergencies
Korea
Logistic Models
Multilevel Analysis
Odds Ratio
Out-of-Hospital Cardiac Arrest*