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Abstract: Objective: It is unclear whether advanced airway management during ambulance transport is associated with improved out-of-hospital cardiac arrest (OHCA) outcomes compared with bag-valve mask ventilation (BVM). This study aimed to determine whether EMT-intermediate ETI or LMA is associated with improved OHCA outcomes in Korea. Methods: We used a Korean national OHCA cohort database composed of hospital and ambulance data. We included all EMS-treated by level 1 EMTs (EMT-intermediate level) and OHCA with presumed cardiac etiology for the period January 2006–December 2008. We excluded cases not receiving continued resuscitation in the emergency department (ED), treated by level 2 EMT, as well as those without available hospital outcome data. The primary exposure was airway management technique during ambulance transport (endotracheal tube (ETI), laryngeal mask airway (LMA) or bag-valve-mask ventilation with an oropharyngeal airway). The primary outcomes were survival to admission and survival to hospital discharge. We compared outcomes between each airway management group using multivariable logistic regression, adjusting for sex, age, witnessed, prehospital defibrillation, bystander cardiopulmonary resuscitation (CPR), call to ambulance arrival time to the scene, call to ambulance arrival time to ED, initial ECG, metropolitan (defined as population>1 million), and level of ED (higher versus lower level). We repeated the analysis using propensity-score matched subsets. Results: Of 54,496 patients with OHCA, we included 5278 (9.7%). Overall survival to admission and to discharge was 20.2% and 6.9%, respectively. ETI and LMA were performed in 250 (4.7%) and 391 (7.4%), respectively. In the full multivariable models using total patients, adjusted survival to admission and discharge were similar for ETI and BVM: OR 0.91 (0.66–1.27) and 1.00 (0.60–1.66), respectively. Adjusted survival to admission and discharge were significantly lower in LMA than BVM: OR 0.72 (0.54–0.95) and 0.52 (0.32–0.85), respectively. In the full multivariable models using propensity matched samples, adjusted survival to admission and discharge were similar for ETI and BVM; OR 1.32 (0.81–2.16) and 1.44 (0.66–3.15), respectively. Adjusted survival to admission was similar for LMA and BVM: OR 0.72 (0.50–1.02). However, survival to discharge was significantly lower for LMA than BVM: OR 0.45 (0.25–0.82). Conclusions: In Korea, EMT-I placed LMA during ambulance transport was associated with worsened OHCA survival to discharge than BVM. Outcomes were similar between EMT-I endotracheal intubation and bag-valve-mask ventilation. [Copyright &y& Elsevier]

Abstract: Objectives: We aimed to describe the epidemiological features and to determine the predictors for survival to discharge of non-traumatic out-of-hospital cardiac arrest (OHCA) in Korea. Subjects and methods: A nationwide Utstein style OHCA database (2006–2007) was constructed from ambulance records and hospital medical record review. Cases were enrolled when they were non-traumatic OHCA with presumed cardiac aetiology. Using the population census (2005), we calculated age–gender standardized incidence rates (SIR) and mortality (SMR). We modelled a multivariate logistic regression analysis to determine the effect of risk factors on hospital outcomes. Results: The total number of EMS-assessed non-traumatic OHCA patients was 19045. The SIR was 20.9 (2006) and 22.2 (2007) per 100000 and survival-to-discharge rate was 2.3% for EMS-assessed non-traumatic OHCA, and was 3.5% for the resuscitation-attempted group. From a multivariate logistic regression analysis, witnessed arrest, and shorter basic life support (BLS) and EMS intervals turned out to be significant predictors of good outcome in the resuscitation-attempted group. Conclusion: From a nationwide OHCA cohort, the incidence of EMS-assessed non-traumatic OHCA was found to be low. Survival-to-discharge rate in the resuscitation-attempted group was 3.5%, which was significantly associated with witnessed arrest, and shorter BLS and EMS intervals. [ABSTRACT FROM AUTHOR]

Abstract: Study objectives: Our objective was to describe the incidence and demographics of pediatric out-of-hospital cardiac arrest (OHCA) in Korea. Methods: We identified non-traumatic OHCA patients aged less than 20 years from a Korean nationwide OHCA registry (2006–2007). Data from emergency medical service (EMS) run-sheets and hospital records were reviewed. We excluded cases with unknown hospital outcomes. Patient characteristics, treatment by EMS, and outcomes were compared by age groups: infant (<1 year), children (1–11 years), and adolescents (12–19 years). Results: A total of 971 patients including infants (n =299, 30.8%), children (n =305, 31.4%), and adolescents (n =367, 37.8%) met inclusion criteria. The incidence of pediatric OHCA was 4.2 per 100,000 person-years (67.1 in infants, 2.5 in children, and 3.5 in adolescents). The rate of cardiopulmonary resuscitation administered was 82.1% (infants 80.6%, children 82.0%, and adolescent 83.4%). The rate of applying automated external defibrillators and advanced airway management (endotracheal intubation or laryngeal mask airway), was only 4.1% and 2.5%, respectively. 7.4% showed ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in the initial ECG. Survival to hospital discharge for all pediatric OHCA was 4.9% (2.9% for infants, 4.7% for children, and 7.2% of adolescents). For EMS-treated pediatric OHCA or patients with VF or pulseless VT, the rate was 5.0% and 31.6%, respectively. Conclusion: Incidence and hospital outcomes in pediatric OHCA in Korea were comparable to other population-based nationwide reports. [Copyright &y& Elsevier]

Objectives: This study aimed to develop and validate a new method for measuring injury severity, the excess mortality ratio-adjusted Injury Severity Score (EMR-ISS), using the International Classification of Diseases 10th Edition (ICD-10)., Methods: An injury severity grade similar to the Abbreviated Injury Scale (AIS) was converted from the ICD-10 codes on the basis of quintiles of the EMR for each ICD-10 code. Like the New Injury Severity Score (NISS), the EMR-ISS was calculated from three maximum severity grades using data from the Korean National Injury Database. The EMR-ISS was then validated using the Hosmer-Lemeshow goodness-of-fit chi-square (HL chi-square, with lower values preferable), the area under the receiver operating characteristic curve (AUC-ROC), and the Pearson correlation coefficient to compare it with the International Classification of Diseases 9th Edition-based Injury Severity Score (ICISS). Nationwide hospital discharge abstract data (DAD) from stratified-sample general hospitals (n = 150) in 2004 were used for an external validation., Results: The total number of study subjects was 29,282,531, with five subgroups of particular interest identified for further study: traumatic brain injury (TBI, n = 3,768,670), traumatic chest injury (TCI,n = 1,169,828), poisoning (n = 251,565), burns (n = 869,020), and DAD (n = 26,374). The HL chi-square was lower for EMR-ISS than for ICISS in all groups: 42,410.8 versus 55,721.9 in total injury, 7,139.6 versus 20,653.9 in TBI, 6,603.3 versus 4,531.8 in TCI, 2,741.2 versus 9,112.0 in poisoning, 764.4 versus 4,532.1 in burns, and 28.1 versus 49.4 in DAD. The AUC-ROC for death was greater for EMR-ISS than for ICISS: 0.920 versus 0.728 in total injury, 0.907 versus 0.898 in TBI, 0.675 versus 0.799 in TCI, 0.857 versus 0.900 in poisoning, 0.735 versus 0.682 in burns, and 0.850 versus 0.876 in DAD. The Pearson correlation coefficient between the two scores was )0.68 in total injury, )0.76 in TBI, )0.86 in TCI, )0.69 in poisoning,)0.58 in burns, and )0.75 in DAD., Conclusions: The EMR-ISS showed better calibration and discrimination power for prediction of death than the ICISS in most injury groups. The EMR-ISS appears to be a feasible tool for passive injury surveillance of large data sets, such as insurance data sets or community injury registries containing diagnosis codes. Additional further studies for external validation on prospectively collected data sets should be considered.