The Analysis of Ilan¡¦s Out-of-Hospital Cardiac Arrest (OHCA) Patients Abstract The study uses Ilan¡¦s out-of-hospital cardiac arrest (OHCA) patients as the research object to understand the variable backgrounds of OHCA patients how they are affected by first aid factors between the period of pre-hospital and post-hospital admission. The study also discusses whether there is a correlation between first aid factors and first aid prognosis among those OHCA patients during pre-hospital and post-hospital admission periods. The study is retrospective and based on the Utstein style format. It collects 284 out-of-hospital cardiac arrest (OHCA) patient cases with trauma and non-trauma (282 effective samples) in an example of a regional teaching hospital in Ilan from 2007 to 2009. It uses descriptive statistics, independent sample t test, and Chi-Square test as the statistical analysis to obtain the following conclusions: 1. There are 282 effective sample patients in the study. There are 57 patients ( 20.2 %) who were return of spontaneous circulation (ROSC) after cardiac arrest approximately 14.77 minutes on average. There are 33 patients (11.7 % ) who survived to be hospitalized for 15.36 days on average, and there are 6 patients ( 2.1 % ) who were discharged from the hospital. 2. Internal medicine disease is the major causative factor of out-of-hospital cardiac arrest. Among those internal medicine disease cases, the history showed hypertension, diabetes mellitus, and heart diseases are the main causes of out-of-hospital cardiac arrest. Patients who are older than 65 years old are the main age groups, accounting for 67.7% of these cases. 3. The pre-hospital admission factors which affect the prognosis after the Emergency Department (ED) are the place of the accident, whether there are witnesses, scene process time , total reaction time , whether automatic external defibrillation was used, and whether people at the scene used CPR. 4. The post-hospital admission factors which affect the prognosis after the ED are initial cardiac rhythm, body temperature, pupil size , dose of epinephrine, whether defibrillation was used, the time of applying emergency first-aid, and medical expense. 5. The percentages of return of spontaneous circulation and survival rates in the study are lower than those of past studies of Taipei City and National Taiwan University Hospital. The possible factors are probably related to differences between rural and urban areas in the quality of emergency medical service systems (EMSS), and healthcare training. 6. From now on, in addition to improving the first-aid continuous monitoring system, we should also enhance EMT related training, and actively educate people to understand and learn CPR, so that comprehensive first-aid systems are available everywhere to effectively increase the success rate of first-aid. Keywords¡GOut-of-hospital cardiac arrest (OHCA), Cardiopulmonary resuscitation

Objective: There is growing evidence that therapeutic hypothermia and other post-resuscitation care improves outcomes in out-of-hospital cardiac arrest (OHCA). Thus, transporting patients with return of spontaneous circulation (ROSC) to specialized facilities may increase survival rates. However, it is unknown whether prolonging transport to reach a designated facility would be detrimental. Methods: Data from OHCA patients treated in EMS systems that cover approximately 70% of Arizona's population were evaluated (October 2004-December 2006). We analyzed the association between transport interval (depart scene to ED arrival) and survival to hospital discharge in adult, non-traumatic OHCA patients and in the subgroup who achieved ROSC and remained comatose. Results: 1846 OHCA occurred prior to EMS arrival. Complete transport interval data were available for 1177 (63.8%) patients (study group). 253 patients (21.5%) achieved ROSC and remained comatose making them theoretically eligible for transport to specialized care. Overall, 70 patients (5.9%) survived and 43 (17.0%) comatose ROSC patients survived. Mean transport interval for the study group was 6.9 min (95% CI: 6.7, 7.1). Logistic regression revealed factors that were independently associated with survival: witnessed arrest, bystander CPR, method of CPR, initial rhythm of ventricular fibrillation, and shorter EMS response time interval. There was no significant association between transport interval and outcome in either the overall study group (OR = 1.2; 0.77, 1.8) or in the comatose, ROSC subgroup (OR 0.94; 0.51, 1.8). Conclusion: Survival was not significantly impacted by transport interval. This suggests that a modest increase in transport interval from bypassing the closest hospital en route to specialized care is safe and warrants further investigation.

No description available.

Introduction: The most appropriate airway management technique for use by paramedics in out-of-hospital cardiac arrest is yet to be determined and evidence relating to the influence of airway management strategy on outcome remains equivocal. In cases where return of spontaneous circulation (ROSC) occurs following out-of-hospital cardiac arrest, patients may undergo direct transfer to a specialist heart attack centre (HAC) where the post resuscitation 12 lead ECG demonstrates evidence of ST elevation myocardial infarction. To date, no studies have investigated the role of airway management strategy on outcomes in this sub-set of patients. The AMICABLE (Airway Management In Cardiac Arrest, Basic, Laryngeal mask airway, Endotracheal intubation) study therefore sought to investigate the influence of prehospital airway management strategy on outcomes in patients transferred by the ambulance service directly to a HAC post ROSC. Methods: Adults with ROSC post out-of-hospital cardiac arrest who met local criteria for transfer to a HAC were identified prospectively. Ambulance records were reviewed to determine prehospital airway management approach and collect physiological and demographic data. HAC notes were obtained to determine in-hospital course and quantify neurological outcome via the Cerebral Performance Category (CPC) scale. Neurologically intact survivors were contacted post discharge to assess quality of life via the SF-36 health survey. Statistical analyses were performed via Chi-square, Mann Whitney U test, odds ratios, and binomial logistic regression. Results: A total of 220 patients were recruited between August 2013 and August 2014, with complete outcome data available for 209. The age of patients ranged from 22-96 years and 71.3% were male (n=149). Airway management was undertaken using a supraglottic airway (SGA) in 72.7% of cases (n=152) with the remainder undergoing endotracheal intubation (ETI). There was no significant difference in the proportion of patients with good neurological outcome (CPC 1&2) between the SGA and ETI groups (p=.286). Similarly, binomial logistic regression incorporating factors known to influence outcome demonstrated no significant difference between the SGA and ETI groups (Adjusted OR 0.725, 95% CI 0.337-1.561). Clinical and demographic variables associated with good neurological outcome included the presence of a shockable rhythm (p < .001), exposure to angiography (p < .001), younger age (p < .001) and shorter time to ROSC (p < .001). Due to an inadequate response rate (25.4%, n=15) analysis of SF36 data was limited to descriptive statistics. Limitations: The study only included patients who achieved ROSC and met the criteria for direct transfer to a HAC. Results are therefore not generalisable to more heterogenous resuscitation populations. Accuracy of clinical decision making and ECG interpretation were not assessed and therefore some patients included in the study may have been inappropriately transferred to a HAC. The low SF-36 survey response rate limited the level of neurological outcome analysis that could be undertaken. Conclusion: In this study, there was no significant difference in the proportion of good neurological outcomes in patients managed with SGA versus ETI during cardiac arrest. Further research incorporating randomised controlled trials is required to provide more definitive evidence in relation to the optimal airway management strategy in out-of-hospital cardiac arrest.

The study is focused on advanced life support (ALS) performed by rescue team physicians in an out-of-hospital setting. The first part of the study analyzes diagnostic possibilities and correctness of assumed aetiology of the sudden cardiac arrest during cardiopulmonary resuscitation (CPR) in the field. It introduces an original method of "Crosscheck Tables" and applies this method to 211 cases of CPR provided by physicians of the Emergency Care Service. The study demonstrates that significantly misleading conclusions can result from a global analysis of a set of cases. It stresses importance of diagnostic analyses applied to individual cases. The second part of the study concentrates on changes in PETCO2 level as related to the return of spontaneous circulation (ROSC - Return of Spontaneous Circulation) as opposed to the circulation fully dependent on chest compressions. The study demonstrates that in constantly ventilated patients undergoing CPR in an out-of-hospital setting, PETCO2 is significantly higher (about 10 mmHg) after ROSC than before ROSC. It demonstrates that a sudden increase in PETCO2 exceeding 10 mmHg is likely to indicate the moment of ROSC. The study also support a view that steadily low levels of PETCO2 values (<10 mmHg) indicate a low chance for a successful resuscitation outcome. Key...

The study is focused on advanced life support (ALS) performed by rescue team physicians in an out-of-hospital setting. The first part of the study analyzes diagnostic possibilities and correctness of assumed aetiology of the sudden cardiac arrest during cardiopulmonary resuscitation (CPR) in the field. It introduces an original method of "Crosscheck Tables" and applies this method to 211 cases of CPR provided by physicians of the Emergency Care Service. The study demonstrates that significantly misleading conclusions can result from a global analysis of a set of cases. It stresses importance of diagnostic analyses applied to individual cases. The second part of the study concentrates on changes in PETCO2 level as related to the return of spontaneous circulation (ROSC - Return of Spontaneous Circulation) as opposed to the circulation fully dependent on chest compressions. The study demonstrates that in constantly ventilated patients undergoing CPR in an out-of-hospital setting, PETCO2 is significantly higher (about 10 mmHg) after ROSC than before ROSC. It demonstrates that a sudden increase in PETCO2 exceeding 10 mmHg is likely to indicate the moment of ROSC. The study also support a view that steadily low levels of PETCO2 values (<10 mmHg) indicate a low chance for a successful resuscitation outcome. Key...