Objective In February 2024, following the announcement of new government healthcare policies, over 90% of resident physicians in South Korea submitted their resignations. This unprecedented staffing disruption raised concerns regarding its potential impact on the care of critically ill patients, particularly those with out-of-hospital cardiac arrest (OHCA). This study evaluated the effect of resident physician staffing disruptions on in-hospital management and outcomes of patients with OHCA.
Methods We conducted a multicenter retrospective observational study of adult patients (≥18 years) with OHCA of medical etiology in a metropolitan city during two periods: a comparison period (March 1–December 31, 2023) and a staffing disruption period (March 1–December 31, 2024). The primary outcomes were survival to hospital discharge and favorable neurologic outcome, defined as a Cerebral Performance Category score of 1–2. Multivariable logistic regression was used to assess the association between study period and outcomes.
Results A total of 1,516 patients were included (736 in the comparison period and 780 in the staffing disruption period). Baseline characteristics and rates of in-hospital interventions, including percutaneous coronary intervention, targeted temperature management, and extracorporeal membrane oxygenation, were similar between groups. The adjusted odds ratios for favorable neurologic outcome and survival to discharge during the staffing disruption period were 1.05 (95% CI, 0.64–1.74) and 1.26 (95% CI, 0.85–1.88), respectively.
Conclusion Short-term outcomes of patients with OHCA were not significantly affected by resident physician staffing disruptions. These findings suggest that emergency care for OHCA may have been preserved during the observed period.
Chanhong Min, Dong Eun Lee, Hyun Wook Ryoo, Haewon Jung, Jae Wan Cho, Yun Jeong Kim, Jae Yun Ahn, Jungbae Park, You Ho Mun, Tae Chang Jang, Sang-chan Jin
Clin Exp Emerg Med 2022;9(3):207-215. Published online August 31, 2022
Objective High-quality cardiopulmonary resuscitation with chest compression is important for good neurologic outcomes during out-of-hospital cardiac arrest (OHCA). Several types of mechanical chest compression devices have recently been implemented in Korean emergency medical services. This study aimed to identify the effect of prehospital mechanical chest compression device use on the outcomes of OHCA patients.
Methods We retrospectively analyzed data drawn from the regional cardiac arrest registry in Daegu, Korea. This registry prospectively collected data from January 2017 to December 2020. Patients aged 18 years or older who experienced cardiac arrest presumed to have a medical etiology were included. The exposure variable was the use of a prehospital mechanical device during transportation by emergency medical technicians. The outcomes measured were neurologic outcomes and survival to discharge. Logistic regression analysis was used.
Results Among 3,230 OHCA patients, 1,111 (34.4%) and 2,119 (65.6%) were managed with manual chest compression and with a mechanical chest compression device, respectively. The mechanical chest compression group showed poorer neurologic outcomes than the manual chest compression group (adjusted odds ratio, 0.12; 95% confidence interval, 0.04–0.33) and decreased survival to discharge (adjusted odds ratio, 0.39; 95% confidence interval, 0.19–0.82) after adjustment for confounding variables.
Conclusion Prehospital mechanical chest compression device use in OHCA was associated with poorer neurologic outcomes and survival to discharge compared to manual chest compression.
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Objective Early defibrillation is crucial for the survival of patients with out-of-hospital cardiac arrest. This study aimed to examine the trends and associated factors regarding public awareness and willingness to use automated external defibrillators (AEDs) through citywide surveys.
Methods Three-round surveys were conducted in February 2012 (n=1,000), December 2016 (n=1,141), and December 2018 (n=1,001) among citizens in Daegu, South Korea, who were aged ≥19 years. The subjects were selected through a three-stage quota sampling. Awareness and willingness to use an AED were assessed in the three groups. The primary outcome was willingness to use AEDs.
Results Of 3,142 respondents, 3,069 were eligible for analysis. The proportion of respondents who knew how to use AEDs increased from 4.7% in 2012 to 20.8% in 2018. Of the respondents in 2012, 2016, and 2018, 39.7%, 50.0%, and 43.2%, respectively, were willing to use an AED. Factors associated with willingness to use AEDs were male sex (adjusted odds ratio [AOR], 1.39; 95% confidence interval [CI], 1.10–1.75), cardiopulmonary resuscitation training experience in the previous 2 years (AOR, 1.80; 95% CI, 1.43–2.28), recognition of the Good Samaritan law (AOR, 1.45; 95% CI, 1.13–1.86), and awareness of how to use an AED (AOR, 4.40; 95% CI, 3.26–5.93).
Conclusion To increase willingness to use AEDs, education in AED use and the Good Samaritan law, along with re-education to maintain knowledge of AED use, should be considered.
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Objective Cardiopulmonary resuscitation (CPR) education with a feedback device is known to result in better CPR skills compared to one without the feedback device. However, its long-term benefits have not been established. The purpose of this study was to evaluate the long-term CPR skill retention after training using real-time visual manikins in comparison to that of non-feedback manikins.
Methods We recruited 120 general university students who were randomly divided into the real-time feedback group (RTFG) and the non-feedback group. Of them, 95 (RTFG, 48; non-feedback group, 47) attended basic life support and automated external defibrillation training for 1 hour. For comparison of retention of CPR skills, the two groups were evaluated based on 2-minute chest compression performed immediately after training and at 3, 6, and 9 months. The CPR parameters between the two groups were also compared using a generalized linear model.
Results At immediately after training, the performance of RTFG was better in terms of average chest compression depth (51.9±1.1 vs. 45.5±1.1, p<0.001) and a higher percentage of adequate chest compression depth (51.0±4.1 vs. 26.9±4.2, p<0.001). This significant difference was maintained until 6 months after training, but there was no difference at 9 months after training. However, there was no significant difference in the chest compression rate and the correct hand position at any time point.
Conclusion CPR training with a real-time visual feedback manikin improved skill acquisition in chest compression depth, but only until 6 months after the training. It could be a more effective educational method for basic life support training in laypersons.
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Objective The incidences of prehospital advanced airway management by emergency medical technicians in South Korea are increasing; however, whether this procedure improves the survival outcomes of patients experiencing out-of-hospital cardiac arrest remains unclear. The present study aimed to investigate the association between prehospital advanced airway management and neurologic outcomes according to a transport time interval (TTI) using the Korean Cardiac Arrest Research Consortium database.
Methods We retrospectively analyzed the favorable database entries that were prospectively collected between October 2015 and December 2016. Patients aged 18 years or older who experienced cardiac arrest that was presumed to be of a medical etiology and that occurred prior to the arrival of emergency medical service personnel were included. The exposure variable was the type of prehospital airway management provided by emergency medical technicians. The primary endpoint was a favorable neurologic outcome.
Results Of 1,871 patients who experienced out-of-hospital cardiac arrest, 785 (42.0%), 121 (6.5%), and 965 (51.6%) were managed with bag-valve-mask ventilation, endotracheal intubation (ETI), and supraglottic airway (SGA) devices, respectively. SGAs and ETI provided no advantage in terms of favorable neurologic outcome in patients with TTIs ≥12 minutes (odds ratio [OR], 1.37; confidence interval [CI], 0.65–2.87 for SGAs; OR, 1.31; CI, 0.30–5.81 for ETI) or in patients with TTI <12 minutes (OR, 0.57; CI, 0.31–1.07 for SGAs; OR, 0.63; CI, 0.12–3.26 for ETI).
Conclusion Neither the prehospital use of SGA nor administration of ETI was associated with superior neurologic outcomes compared with bag-valve-mask ventilation.
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