Dual-dispatch protocols and return of spontaneous circulation in patients with out-of-hospital cardiac arrest: a nationwide observational study

Seung Hyo Lee; Young Su Kim; Jeseong Park; Hyouk Jae Lim; Won Pyo Hong

doi:10.15441/ceem.23.177

Original Article

doi: https://doi.org/10.15441/ceem.23.177 [Accepted]

Dual-dispatch protocols and return of spontaneous circulation in patients with out-of-hospital cardiac arrest: a nationwide observational study

Seung Hyo Lee^1,2

, Young Su Kim¹

, Jeseong Park¹

, Hyouk Jae Lim³

, Won Pyo Hong^3,4

¹119 EMS Division, National Fire Agency 119, Sejong, Korea
²National Fire Research Institute, Asan, Korea
³Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
⁴National Emergency Medical Center, National Medical Center, Seoul, Korea

Correspondence Won Pyo Hong Email: pyotang@gmail.com

Received: December 15, 2023. Revised: March 7, 2024. Accepted: March 19, 2024. Published online: April 5, 2024.

ABSTRACT

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.

Keywords: Ambulances; Advanced Cardiac Life Support; Out-of-hospital cardiac arrest; Emergency medical services; Return of spontaneous circulation; Airway management; Epinephrine