Association between Mode of Transport and Patient Outcomes in the Emergency Department following Out-of-Hospital Cardiac Arrest: A Single-Center Retrospective Study

Abstract

Background

Out-of-hospital cardiac arrest (OHCA) remains a health problem worldwide, carrying a high mortality rate. Comparison of emergency department (ED) return of spontaneous circulation (ROSC) after OHCA in relation to emergency medical services (EMS) and non-EMS modes of transportation to the hospital was conducted to assess the impact points of the EMS system in Thailand.

Methods

This retrospective observational study enrolled all OHCA patients who visited the ED of Ramathibodi Hospital, a tertiary university hospital in Bangkok, between January 1, 2008, and May 31, 2020. Patients were differentiated into EMS and non-EMS groups according to mode of transportation to the ED. Patients’ characteristics and comorbidities, witnessed arrests, bystander chest compression, initial rhythm, and resuscitation treatment were documented. ED-sustained ROSC, ED survival, 30-day survival, and 30-day survival with good cerebral performance category (CPC) scores were monitored and recorded. Multivariate logistic analyses were performed to assess factors influencing clinical outcomes.

Results

A total of 339 patients were enrolled, 117 (34.51%) of whom were in the EMS transport group. There were no differences between the EMS and non-EMS groups in ED-sustained ROSC (adjusted odds ratio [aOR], 0.99; 95% confidence interval [CI], 0.58–1.70; P = 0.98), or ED survival (aOR, 0.99; 95% CI, 0.57–1.71; P = 0.97). There were also no differences in 30-day survival or 30-day survival with good CPC score between the two groups.

Conclusions

In our cohort data of OHCA, ED-sustained ROSC and ED survival outcomes were not superior in the EMS transportation group. Evidence to show that EMS transportation affected 30-day survival and 30-day good CPC score was also lacking. Thus, public promotion of Thailand’s EMS system is advocated with a simultaneous improvement of EMS response to enhance OHCA outcomes.

Acknowledgments

We thank Hugh McGonigle, from Edanz (https://www.edanz.com/ac), for editing a draft of the manuscript.

Authors' Contributions

PS, KS, and PP designed this study and developed the protocol. KS, MP, and YM were responsible for data collection. PS and KS were responsible for data analysis. PS and KS wrote the manuscript. PS and PP provided final approval for this version to be published. PS and PP agree to be accountable for all aspects of the work. All authors read and approved the final manuscript.

Data Availability Statement

The datasets analyzed during the current study are available in the Harvard Dataverse repository [https://doi.org/10.7910/DVN/MSJB3G]

Disclosure Statement

No potential conflict of interest was reported by the authors.

Ethical Approval and Consent to Participate

All methods were performed following the relevant guidelines and regulations for human research (Declarations of Helsinki). The study was approved by the ethics committee of the Faculty of Medicine, Ramathibodi Hospital, Mahidol University (IRB COA. MURA2020/912. Date May 27, 2020).

As this study used secondary data, obtaining informed consent was waived by the ethics committee of the Faculty of Medicine, Ramathibodi Hospital, Mahidol University.