Objective The Korean National Fire Agency conducted a pilot project examining Advanced Life Support (ALS) protocols, including epinephrine administration, to improve survival among patients suffering out-of-hospital cardiac arrest (OHCA). In this study, we aimed to evaluate the effects of the Korean National Fire Agency ALS protocol on prehospital return of spontaneous circulation (ROSC) in patients with OHCA.
Methods This study included patients with adult-presumed cardiac arrest between January and December 2020. The main factor of interest was ambulance type according to ALS protocol, which was divided into dedicated ALS ambulance (DA), smartphone-based ALS ambulance (SALS), and non-DA, and the main analysis factor was prehospital ROSC. Multivariate logistic regression analysis was performed.
Results During the study period, a total of 18,031 adult patients with OHCA was treated by the emergency medical services, including 7,520 DAs (41.71%), 2,622 SALSs (14.54%), and 7,889 non-DAs (43.75%). The prehospital ROSC ratio was 13.19% for DA, 11.17% for SALS, and 7.91% for non-DA (P<0.01). Compared with that of the DA group, the odds ratios (95% confidence interval) for prehospital ROSC ratio were 0.97 (0.82–1.15) in the SALS group and 0.57 (0.50–0.65) in the non-DA group. The prehospital ROSC ratio of the DA group was higher than those of the non-DA group and the SALS group.
Conclusion ALS protocol intervention was associated with prehospital ROSC rates. Therefore, continuous efforts to promote systemic implementation of the ALS protocol to improve OHCA outcomes are necessary.
Citations
Citations to this article as recorded by
Video-vs audio-instructed dispatcher-assisted CPR and outcomes after out-of-hospital cardiac arrest: a nationwide registry-based cohort study Seung Hyo Lee, Tae Han Kim, Won Pyo Hong, Sang Do Shin, Kyoung Jun Song, Young Sun Ro, Jeong Ho Park, Goeun Kim, Seulki Choi Resuscitation.2026; 220: 111009. CrossRef
Impact of bystander and patient sex on cardiopulmonary resuscitation provision in out-of-hospital cardiac arrest Seunggu Na, Kyung Hun Yoo, Jaehoon Oh, Yongil Cho, Juncheol Lee, Tae Ho Lim, Hyunggoo Kang, Byuk Sung Ko, Jinsoo Kim Emergency Medicine Journal.2026; 43(8): 479. CrossRef
Radiological eye deviation as a prognostic marker in patients post–cardiac arrest: a retrospective observational study Jae Hwan Kim, Chiwon Ahn, Young Taeck Oh Clinical and Experimental Emergency Medicine.2026; 13(3): 303. CrossRef
Impact of the emergency medical services crew size (2 vs. ≥3 personnel) on prehospital performance and survival in severe trauma: a nationwide cohort study in Korea Seung Hyo Lee, Won Pyo Hong, Kyoungwon Jung, Hangjoo Cho, Mi Yeon Lee, Hwan Seon Moon Journal of Trauma and Injury.2026; 39(3): 224. CrossRef
Temporal Evolution of Optic Nerve Sheath Diameter/Eyeball Ratio on CT and MRI for Neurological Prognostication After Cardiac Arrest Jiyoung Choi, So-Young Jeon, Jung Soo Park, Jin A Lim, Byung Kook Lee Journal of Clinical Medicine.2025; 14(19): 6891. CrossRef
Objective We hypothesized that a multi-tier response (MTR) will provide high-quality cardiopulmonary resuscitation including airway management. However, the type of tier response system and airway management will have different interactive effects resulting in varying outcomes following out-of-hospital cardiac arrest (OHCA). This study aimed to determine whether the advanced airway management method has an effect on OHCA outcomes and to compare the size of the effect across MTR types.
Methods This is a retrospective population-based observational study using the Korea OHCA Registry. Airway management methods were categorized into endotracheal intubation (ETI) and supraglottic airway (SGA) groups. The tier system was categorized into single-tier response (STR) or two types of MTR: ambulance-ambulance MTR or fire engine-ambulance MTR.
Results In total, 45,264 patients were analyzed among the 89,087 emergency medical service assessed OHCAs. The SGA group was significantly associated with a lower prehospital return of spontaneous circulation (ROSC) rate compared to the ETI group (adjusted odds ratio [aOR], 0.79; 95% confidence interval [CI], 0.72–0.88). Both MTR with an ambulance or fire engine were significantly associated with higher prehospital ROSC rates compared to STR (STR vs. MTR with an ambulance: aOR, 1.33; 95% CI, 1.21–1.47; STR vs. MTR with a fire engine: aOR, 1.43; 95% CI, 1.20–1.71). Prehospital SGA was significantly associated with poor neurological outcomes in MTR with fire engine (aOR, 0.71; 95% CI, 0.53–0.96).
Conclusion In this nationwide observational study, we observed that MTR was associated with higher prehospital ROSC than STR. Moreover, SGA is associated with a lower prehospital ROSC rate regardless of tier response type compared to ETI.
Citations
Citations to this article as recorded by
Assessing the need for quality control in direct medical oversight: a survey of emergency medical services providers and medical directors Daesung Lim, Sun Hyu Kim, Seong Chun Kim, Song Yi Park, Bongkyu Jeong Journal of EMS Medicine.2026; 5(1): 1. CrossRef
The Benefit of Early Advanced Airway Management Depends on Prehospital Epinephrine Timing in Out-of-Hospital Cardiac Arrest: A Nationwide Cohort Study Hyeong seon Kim, Ki Jeong Hong, Ki Hong Kim, Sang Do Shin, Kyoung Jun Song, Jeong Ho Park, Min Woo Kim, Dong Hyun Choi, Young Sun Ro, Joo Jeong, Yong Joo Park The Journal of Emergency Medicine.2026; 90: 108. CrossRef
Association Between the Number of Emergency Medical Services and the Chest Compression Quality in Out-of-Hospital Cardiac Arrest Sang A. Yoon, Ki Hong Kim, Jeong Ho Park, Tae Han Kim, Stephen Gyung Won Lee, Ki Jeong Hong, Young Sun Ro, Kyoung Jun Song, Sang Do Shin The Journal of Emergency Medicine.2025; 75: 89. CrossRef
Current trends in emergency airway management: a clinical review Sangun Nah, Yonghee Lee, Sol Ji Choi, Jeongwoo Lee, Soyun Hwang, Seongmi Lim, Inhye Lee, Young Soon Cho, Hyun Soo Chung Clinical and Experimental Emergency Medicine.2024; 11(3): 243. CrossRef
Interaction effects between insomnia and depression on risk of out-of-hospital cardiac arrest: Multi-center study Eujene Jung, Hyun Ho Ryu, Sung Wan Kim, Jung Ho Lee, Kyoung Jun Song, Young Sun Ro, Kyoung Chul Cha, Sung Oh Hwang, Billy Morara Tsima PLOS ONE.2023; 18(8): e0287915. CrossRef
First
Prev
