ABSTRACT
A thesis was submitted to the committee of Graduate School of Kongju National University in partial fulfillment of the requirements for the degree of Master of Emergency Medical Service conferred in February, 2020.
Impact Affecting the Return of Spontaneous Circulation and...
ABSTRACT
A thesis was submitted to the committee of Graduate School of Kongju National University in partial fulfillment of the requirements for the degree of Master of Emergency Medical Service conferred in February, 2020.
Impact Affecting the Return of Spontaneous Circulation and Good Neurological Outcome by both the Witness of Out of Hospital Cardiac Arrest and the Basic Life Support of the Bystander.
Mi-seong Lim
Department of Emergency Medical Service
Graduate School of Kongju National University
Gong ju, Korea
(Supervised by Professor Eun-Sook Choi)
Objective : This retrospective study was conducted to determine the impact affecting the Return of Spontaneous Circulation (ROSC) and Good Neurological Outcome by dividing EMS Response Time in 4 minutes according to bystander witnessed cardiac arrest in Out-of-hospital Cardiac Arrest(OHCA), whether Basic Life Support(BLS) was performed by the bystander, and whether initial electrocardiogram rhythm given by the paramedics is shockable or non-shockable according to the rate of resuscitation.
Methods : The patients who reported as cardiac arrest or confirmed cardiac arrest during transfer for 3 years from January 1, 2016 to December 31, 2018 at K-Fire Department 119 were 11,576 patients. This study was conducted on 2,898 subjects except for the 8,687 subjects who were excluded due to following criteria: subjects who were un-transferred or CPR was not performed by the paramedics, subjects were under age of 18, and subjects with no record analysis of ECG etc. As a research tool, EMS report, a detailed table of EMS for cardiopulmonary arrest patients, and a heart saver award ledger were received from the K-Fire Department 119 (Bill Number: 5259175) and IRB approval (KNU_IRB_2019-24) was received from the Kongju National University. The data was analyzed using frequency and percentage, mean and standard deviation, χ²-test, Fisher's Exact Test, and logistic regression using IBM SPSS Statistics Version 25.0. The significance level was p<.05.
Results : The major findings were as follows.
1. The general characteristics of the subjects were men 62.7% (1,817 patients), mean age 71 ± 14.8 years old, 50.3%(1,456 patients) without medical history, 69.5%(2,015 patients) at home where cardiac arrest occurred, and 54% of the respondents(1,564 patients) witnessed cardiac arrest rate, 70.2%(203 patients) of the bystander-performed CPR, 17.6% (511 patients) of the initial shockable rhythm, 6.9%(199 patients) of the defibrillator used subjects, 17 ± 8 minutes mean time taken from initial call to ROSC, the spontaneous circulation recovery rate was 7.1%(206 patients), and the good neurological recovery rate was 5.1%(149 patients).
2. The ROSC rate according to the characteristics of the bystander was 10.9%(171 patients) when cardiac arrest was witnessed, 8.8%(178 patients) given CPR, 26.9%(14 patients) of the subject received defibrillation shock, 6.8%(184 people) did not receive defibrillation. Good Neurological Outcome rate was 8.3%(130 patients) with observing cardiac arrest, 6.5%(133 patients) with CPR, 25.0%(13 patients) with defibrillation shock, 4.9%(132 patients) without defibrillators. There was a statistically significant difference in every characteristic(p<.000).
3. The highest resuscitation rate was in witnessing cardiac arrest with shockable rhythm and ROSC rate being 37.7%(146 patients) and Good Neurological Outcome rate was 31.5%(122 patients).
4. The factors affecting ROSC of the subjects were that when the bystander witnessed cardiac arrest, the ROSC rate increased by 4.125 times (95% CI, 2.816-6.044; p<.000). And the increase was 2.363(95% CI, 1.534-3.640; p<.000) times when the bystander performed CPR. 3.630(95% CI, 1.765-7.468; p<.000) times increase was observed when the defibrillation was performed by the bystander. The ROSC rate decreased by 0.998(95% CI, 0.997-0.998; p<.000) times with every 1-minute increase in EMS response time.
5. Factors affecting the subject's Good Neurological Outcome increased by 5.783 (95% CI, 3.514-9.518; p<.000) times when the bystander witnessed cardiac arrest, and 2.718(95% CI, 1.572-4.701; p<.000) times increased when CPR was given by the bystander. 6.718(95% CI, 2.956-14.234; p<.000) times increaseds when the defibrillation was performed by the bystander. The ROSC rate decreased by 0.998(95% CI, 0.997-0.998; p<.000) times with every 1-minute increase in EMS response time.
Conclusion: Resuscitation of acute cardiac arrest should be expected to restore brain function beyond ROSC. The impact affecting ROSC and Good Neurological Outcome were the same, and the resuscitation rate increased with the bystander’s witness, the bystander’s cardiopulmonary resuscitation, and the defibrillation. Resuscitation rate decreased as the EMS Response Time increased. Institutional review is needed to increase the use of defibrillators to improve the resuscitation rate of acute cardiac arrest. It is necessary to have a defibrillator installed mandatorily if the house and the apartment have more than certain number of households according to the standard installment rules in 500 households containing apartment.
In addition, when educating CPR to general public, it is necessary for them to understand and be taught about ‘exemption for the responsibility in emergency medical treatment of gool will of Emergency Medical Service Act’ to enhance the willingness to perform CPR.
ABSTRACT
A thesis was submitted to the committee of Graduate School of Kongju National University in partial fulfillment of the requirements for the degree of Master of Emergency Medical Service conferred in February, 2020.
Impact Affecting the Return of Spontaneous Circulation and Good Neurological Outcome by both the Witness of Out of Hospital Cardiac Arrest and the Basic Life Support of the Bystander.
Mi-seong Lim
Department of Emergency Medical Service
Graduate School of Kongju National University
Gong ju, Korea
(Supervised by Professor Eun-Sook Choi)
Objective : This retrospective study was conducted to determine the impact affecting the Return of Spontaneous Circulation (ROSC) and Good Neurological Outcome by dividing EMS Response Time in 4 minutes according to bystander witnessed cardiac arrest in Out-of-hospital Cardiac Arrest(OHCA), whether Basic Life Support(BLS) was performed by the bystander, and whether initial electrocardiogram rhythm given by the paramedics is shockable or non-shockable according to the rate of resuscitation.
Methods : The patients who reported as cardiac arrest or confirmed cardiac arrest during transfer for 3 years from January 1, 2016 to December 31, 2018 at K-Fire Department 119 were 11,576 patients. This study was conducted on 2,898 subjects except for the 8,687 subjects who were excluded due to following criteria: subjects who were un-transferred or CPR was not performed by the paramedics, subjects were under age of 18, and subjects with no record analysis of ECG etc. As a research tool, EMS report, a detailed table of EMS for cardiopulmonary arrest patients, and a heart saver award ledger were received from the K-Fire Department 119 (Bill Number: 5259175) and IRB approval (KNU_IRB_2019-24) was received from the Kongju National University. The data was analyzed using frequency and percentage, mean and standard deviation, χ²-test, Fisher's Exact Test, and logistic regression using IBM SPSS Statistics Version 25.0. The significance level was p<.05.
Results : The major findings were as follows.
1. The general characteristics of the subjects were men 62.7% (1,817 patients), mean age 71 ± 14.8 years old, 50.3%(1,456 patients) without medical history, 69.5%(2,015 patients) at home where cardiac arrest occurred, and 54% of the respondents(1,564 patients) witnessed cardiac arrest rate, 70.2%(203 patients) of the bystander-performed CPR, 17.6% (511 patients) of the initial shockable rhythm, 6.9%(199 patients) of the defibrillator used subjects, 17 ± 8 minutes mean time taken from initial call to ROSC, the spontaneous circulation recovery rate was 7.1%(206 patients), and the good neurological recovery rate was 5.1%(149 patients).
2. The ROSC rate according to the characteristics of the bystander was 10.9%(171 patients) when cardiac arrest was witnessed, 8.8%(178 patients) given CPR, 26.9%(14 patients) of the subject received defibrillation shock, 6.8%(184 people) did not receive defibrillation. Good Neurological Outcome rate was 8.3%(130 patients) with observing cardiac arrest, 6.5%(133 patients) with CPR, 25.0%(13 patients) with defibrillation shock, 4.9%(132 patients) without defibrillators. There was a statistically significant difference in every characteristic(p<.000).
3. The highest resuscitation rate was in witnessing cardiac arrest with shockable rhythm and ROSC rate being 37.7%(146 patients) and Good Neurological Outcome rate was 31.5%(122 patients).
4. The factors affecting ROSC of the subjects were that when the bystander witnessed cardiac arrest, the ROSC rate increased by 4.125 times (95% CI, 2.816-6.044; p<.000). And the increase was 2.363(95% CI, 1.534-3.640; p<.000) times when the bystander performed CPR. 3.630(95% CI, 1.765-7.468; p<.000) times increase was observed when the defibrillation was performed by the bystander. The ROSC rate decreased by 0.998(95% CI, 0.997-0.998; p<.000) times with every 1-minute increase in EMS response time.
5. Factors affecting the subject's Good Neurological Outcome increased by 5.783 (95% CI, 3.514-9.518; p<.000) times when the bystander witnessed cardiac arrest, and 2.718(95% CI, 1.572-4.701; p<.000) times increased when CPR was given by the bystander. 6.718(95% CI, 2.956-14.234; p<.000) times increaseds when the defibrillation was performed by the bystander. The ROSC rate decreased by 0.998(95% CI, 0.997-0.998; p<.000) times with every 1-minute increase in EMS response time.
Conclusion: Resuscitation of acute cardiac arrest should be expected to restore brain function beyond ROSC. The impact affecting ROSC and Good Neurological Outcome were the same, and the resuscitation rate increased with the bystander’s witness, the bystander’s cardiopulmonary resuscitation, and the defibrillation. Resuscitation rate decreased as the EMS Response Time increased. Institutional review is needed to increase the use of defibrillators to improve the resuscitation rate of acute cardiac arrest. It is necessary to have a defibrillator installed mandatorily if the house and the apartment have more than certain number of households according to the standard installment rules in 500 households containing apartment.
In addition, when educating CPR to general public, it is necessary for them to understand and be taught about ‘exemption for the responsibility in emergency medical treatment of gool will of Emergency Medical Service Act’ to enhance the willingness to perform CPR.
주제어
#Key words: OHCA cardiac arrest ROSC EMS Response Good neurological outcome AED BLS CPR
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