Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest
Main Article Content
Keywords
emergency medical technician, paramedic, out-of-hospital cardiac arrest, return of spontaneous circulation
Abstract
The role of emergency medical technicians (EMTs) in providing advanced life support (ALS) for out-of-hospital cardiac arrest (OHCA) patients is crucial, yet the optimal EMT configuration remains a topic of debate. This three-year cohort study focused on non-traumatic OHCA adults treated by ALS teams , utilizing an Utstein-style population database. The study examined the impact of the EMT-paramedic (EMT-P) ratio, defined as the proportion of EMT-Ps among on-scene EMTs, on patient outcomes. Among 1357 eligible cases, the median number of on-scene EMTs was 2, with an EMT-P ratio ranging from 50% to 100%. Multivariate analysis identified several predictors of sustained return of spontaneous circulation (ROSC), including younger age, witnessed cardiac arrest, prehospital ROSC, prehospital defibrillation, and comorbid diabetes mellitus. After adjusting for confounders, each 10% increase in the EMT-P ratio was associated with an 8% higher chance of sustained ROSC (adjusted odds ratio [aOR], 1.08; p < 0.01) and a 12% higher likelihood of favorable neurologic status at discharge (aOR, 1.12; p = 0.048). Conversely, the number of on-scene EMTs did not significantly impact outcomes. This study underscores the importance of EMT-P ratio in improving outcomes for non-traumatic OHCA adults, highlighting the potential benefits of optimizing EMT configurations.
References
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21. Wang H.E., Schmicker R.H., Daya M.R., Stephen S.W., Idris A.H., Carldon J.N., Colella M.R., Herren H., Hansen M., Richmond N.J., et al. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2018;320:769–778. doi: 10.1001/jama.2018.7044.
22. Lin C.H., Chiang W.C., Ma M.H., Wu S.Y., Tsai M.C., Chi C.H. Use of automated external defibrillators in patients with traumatic out-of-hospital cardiac arrest. Resuscitation. 2013;84:586–591. doi: 10.1016/j.resuscitation.2012.09.028.
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30. O’Keeffe C., Nicholl J., Turner J., Goodacre S. Role of ambulance response times in the survival of patients with out-of-hospital cardiac arrest. Emerg. Med. J. 2011;28:703–706. doi: 10.1136/emj.2009.086363.
31. Shin S.D., Kitamura T., Hwang S.S., Kajino K., Song K.J., Ro Y.S., Nischiuchi T., Iwami T. Association between resuscitation time interval at the scene and neurological outcome after out-of-hospital cardiac arrest in two Asian cities. Resuscitation. 2014;85:203–210. doi: 10.1016/j.resuscitation.2013.10.021.
32. Geri G., Gilgan J., Wu W., Vijendira S., Ziegler C., Drennan I.R., Morrison L., Lin S. Does transport time of out-of-hospital cardiac arrest patients matter? A systematic review and meta-analysis. Resuscitation. 2017;115:96–101. doi: 10.1016/j.resuscitation.2017.04.003.
33. Swor R.A., Jackson R.E., Compton S., Domeier R., Zalenski R., Honeycutt L., Kuhn G.J., Frederiksen S., Pascual R.G. Cardiac arrest in private locations: Different strategies are needed to improve outcome. Resuscitation. 2003;58:171–176. doi: 10.1016/S0300-9572(03)00118-7.
34. Chiang W.C., Chen S.Y., Ko P.C., Hsieh M.J., Wang H.C., Huang E.P.C., Yang C.W., Chong K.M., Chen W.T., Chen S.Y., et al. Prehospital intravenous epinephrine may boost survival of patients with traumatic cardiac arrest: A retrospective cohort study. Scand. J. Trauma Resusc. Emerg. Med. 2015;23:102. doi: 10.1186/s13049-015-0181-4.
35. Wang C.H., Chou N.K., Becker L.B., Lin J.W., Yu H.Y., Chi N.H., Hunag S.C., Ko W.J., Wang S.S., Tseng L.J., et al. Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest—A comparison with that for extracorporeal rescue for in-hospital cardiac arrest. Resuscitation. 2014;85:1219–1224. doi: 10.1016/j.resuscitation.2014.06.022.
36. Nolan J.P., Soar J., Cariou A., Cronberg T., Moulaert V.R., Deakin C.D., Bottiger B.W., Friberg H., Sunde K., Sandroni C. European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care. Intensive Care Med. 2015;41:2039–2056. doi: 10.1007/s00134-015-4051-3.
37. Dyson K., Bray J.E., Smith K., Bernard S., Straney L., Finn J. Paramedic Exposure to Out-of-Hospital Cardiac Arrest Resuscitation Is Associated With Patient Survival. Circ. Cardiovasc. Qual. Outcomes. 2016;9:154–160. doi: 10.1161/CIRCOUTCOMES.115.002317.
38. Tuttle J.E., Hubble M.W. Paramedic Out-of-hospital Cardiac Arrest Case Volume Is a Predictor of Return of Spontaneous Circulation. West J. Emerg. Med. 2018;19:654–659. doi: 10.5811/westjem.2018.3.37051.
39. Lin C.H., Ng Y.Y., Chiang W.C., Karim S.A., Shin S.D., Tanaka H., Nishiuchi T., Kajino K., Khunkhlai N., Ma M.H., et al. Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries. J. Formos. Med. Assoc. 2016;115:628–638. doi: 10.1016/j.jfma.2015.10.003.
40. Lu C.H., Fang P.H., Lin C.H. Dispatcher-assisted cardiopulmonary resuscitation for traumatic patients with out-of-hospital cardiac arrest. Scand. J. Trauma Resusc. Emerg. Med. 2019;27:97. doi: 10.1186/s13049-019-0679-2.
2. Mozaffarian D., Benjamin E.J., Go A.S., Arnett D.K., Blaha M.J., Cushman M., Das S.R., de Ferranti S., Despres J.P., Fullerton H.J., et al. Heart disease and stroke statistics—2015 update: A report from the American Heart Association. Circulation. 2015;131:e29–e322. doi: 10.1161/CIR.0000000000000152.
3. Wang C.Y., Wang J.Y., Teng N.C., Chao T.T., Tsai S.L., Chen C.L., Hsu J.Y., Wu C.P., Lai C.C., Chen L. The secular trends in the incidence rate and outcomes of out-of-hospital cardiac arrest in Taiwan—A nationwide population-based study. PLoS ONE. 2015;10:e0122675. doi: 10.1371/journal.pone.0122675.
4. Kleinman M.E., Brennan E.E., Goldberger Z.D., Swor R.A., Terry M., Bobrow B.J., Gazmuri R.J., Travers A.H., Rea T. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S414–S435. doi: 10.1161/CIR.0000000000000259.
5. Link M.S., Berkow L.C., Kudenchuk P.J., Halperin H.R., Hess E.P., Moitra V.K., Heumar R.W., O’Neil B.J., Paxton J.H., Silvers S.M., et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S444–S464. doi: 10.1161/CIR.0000000000000261.
6. Bakalos G., Mamali M., Komninos C., Koukou E., Tsantilas A., Tzima S., Rosenberg T. Advanced life support versus basic life support in the pre-hospital setting: A meta-analysis. Resuscitation. 2011;82:1130–1137. doi: 10.1016/j.resuscitation.2011.04.006.
7. Hasegawa K., Hiraide A., Chang Y., Brown D.F. Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA. 2013;309:257–266. doi: 10.1001/jama.2012.187612.
8. Sanghavi P., Jena A.B., Newhouse J.P., Zaslavsky A.M. Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support. JAMA Intern. Med. 2015;175:196–204. doi: 10.1001/jamainternmed.2014.5420.
9. Hagihara A., Onozuka D., Nagata T., Hasegawa M. Effects of advanced life support on patients who suffered cardiac arrest outside of hospital and were defibrillated. Am. J. Emerg. Med. 2018;36:73–78. doi: 10.1016/j.ajem.2017.07.018.
10. Ministry of Justice, Republic of China; 2008. [(accessed on 15 July 2019)]. Training Course of EMT-Intermediate. Available online: https://law.moj.gov.tw/LawClass/LawGetFile.ashx?FileId=0000234403&lan=C.
11. Ministry of Justice, Republic of China; 2008. [(accessed on 15 July 2019)]. Training Course of EMT-Paramedic. Available online: https://law.moj.gov.tw/LawClass/LawGetFile.ashx?FileId=0000234404&lan=C.
12. Ministry of Justice, Republic of China; 2008. [(accessed on 15 July 2019)]. Regulations Governing Emergency Medical Technicians. Available online: https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020141.
13. Kajino K., Kitamura T., Iwami T., Daya M., Ong M.E.H., Nishiyama C., Sakai T., Tanigawa K.S., Hayashida S., Nishiuchi T., et al. Impact of the number of on-scene emergency life-saving technicians and outcomes from out-of-hospital cardiac arrest in Osaka City. Resuscitation. 2014;85:59–64. doi: 10.1016/j.resuscitation.2013.09.002.
14. Warren S.A., Prince D.K., Huszti E., Rea T.D., Fitzpatrick A.L., Andrusiek D.L., Darling S., Morrison L.J., Vilke G.M., Nichol G., et al. Volume versus outcome: More emergency medical services personnel on-scene and increased survival after out-of-hospital cardiac arrest. Resuscitation. 2015;94:40–48. doi: 10.1016/j.resuscitation.2015.02.019.
15. Eschmann N.M., Pirrallo R.G., Aufderheide T.P., Lerner E.B. The association between emergency medical services staffing patterns and out-of-hospital cardiac arrest survival. Prehosp. Emerg. Care. 2010;14:71–77. doi: 10.3109/10903120903349820.
16. Hagiwara S., Oshima K., Aoki M., Miyazaki D., Sakurai A., Tahara Y., Nagao K., Yonemoto N., Yaguchi A., Morimura N. Does the number of emergency medical technicians affect the neurological outcome of patients with out-of-hospital cardiac arrest? Am. J. Emerg. Med. 2017;35:391–396. doi: 10.1016/j.ajem.2016.11.020.
17. Sun J.T., Chiang W.C., Hsieh M.J., Huang E.P.C., Yang W.S., Chien Y.C., Wang Y.C., Lee B.C., Sim S.S., Tsai K.C., et al. The effect of the number and level of emergency medical technicians on patient outcomes following out of hospital cardiac arrest in Taipei. Resuscitation. 2018;122:48–53. doi: 10.1016/j.resuscitation.2017.11.048.
18. Dawson D.E., Brown W.E., Jr., Harwell T.S. Assessment of nationally registered emergency medical technician certification training in the United States: The LEADS Project. Longitudinal Emergency Medical Technician Attributes Demo-graphic Study. Prehosp. Emerg. Care. 2003;7:114–119. doi: 10.1080/10903120390937210.
19. Travers A.H., Rea T.D., Bobrow B.J., Edeison D.P., Berg R.A., Sayre M.R., Berg M.D., Chameides L., O’Connor R.E., Swor R.A. Part 4: CPR overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S676–S684. doi: 10.1161/CIRCULATIONAHA.110.970913.
20. Chiang W.C., Ko P.C., Wang H.C., Yang C.W., Shih F.Y., Hsiung K.H., Ma M.H.M. EMS in Taiwan: Past, present, and future. Resuscitation. 2009;80:9–13. doi: 10.1016/j.resuscitation.2008.10.010.
21. Wang H.E., Schmicker R.H., Daya M.R., Stephen S.W., Idris A.H., Carldon J.N., Colella M.R., Herren H., Hansen M., Richmond N.J., et al. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2018;320:769–778. doi: 10.1001/jama.2018.7044.
22. Lin C.H., Chiang W.C., Ma M.H., Wu S.Y., Tsai M.C., Chi C.H. Use of automated external defibrillators in patients with traumatic out-of-hospital cardiac arrest. Resuscitation. 2013;84:586–591. doi: 10.1016/j.resuscitation.2012.09.028.
23. Peduzzi P., Concato J., Kemper E., Holford T.R., Feinstein A.R. A simulation study of the number of events per variable in logistic regression analysis. J. Clin. Epidemiol. 1996;49:1373–1379. doi: 10.1016/S0895-4356(96)00236-3.
24. Royston P., Moons K.G., Altman D.G., Vergouwe Y. Prognosis and prognostic research: Developing a prognostic model. BMJ. 2009;338:b604. doi: 10.1136/bmj.b604.
25. Gold L.S., Eisenberg M.S. The effect of paramedic experience on survival from cardiac arrest. Prehosp. Emerg. Care. 2009;13:341–344. doi: 10.1080/10903120902935389.
26. Bayley R., Weinger M., Meador S., Slovis C. Impact of ambulance crew configuration on simulated cardiac arrest resuscitation. Prehosp. Emerg. Care. 2008;12:62–68. doi: 10.1080/10903120701708011.
27. Hunziker S., Johansson A.C., Tschan F., Semmer N.K., Rock L., Howell M.D., Marsch S. Teamwork and leadership in cardiopulmonary resuscitation. J. Am. Coll. Cardiol. 2011;57:2381–2388. doi: 10.1016/j.jacc.2011.03.017.
28. Finn J.C., Bhanji F., Lockey A., Monsieurs K., Frengley R., Iwami T., Lang E., Ma M.H.M., Mancini M.E., McNeil M.A., et al. Part 8: Education, implementation, and teams: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2015;95:e203–e224. doi: 10.1016/j.resuscitation.2015.07.046.
29. Perkins G.D., Ji C., Deakin C.D., Quinn T., Nolan J.P., Scomparin C., Regan S., Slowther A., Pocock H., Black J.J.M., et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N. Engl. J. Med. 2018;379:711–721. doi: 10.1056/NEJMoa1806842.
30. O’Keeffe C., Nicholl J., Turner J., Goodacre S. Role of ambulance response times in the survival of patients with out-of-hospital cardiac arrest. Emerg. Med. J. 2011;28:703–706. doi: 10.1136/emj.2009.086363.
31. Shin S.D., Kitamura T., Hwang S.S., Kajino K., Song K.J., Ro Y.S., Nischiuchi T., Iwami T. Association between resuscitation time interval at the scene and neurological outcome after out-of-hospital cardiac arrest in two Asian cities. Resuscitation. 2014;85:203–210. doi: 10.1016/j.resuscitation.2013.10.021.
32. Geri G., Gilgan J., Wu W., Vijendira S., Ziegler C., Drennan I.R., Morrison L., Lin S. Does transport time of out-of-hospital cardiac arrest patients matter? A systematic review and meta-analysis. Resuscitation. 2017;115:96–101. doi: 10.1016/j.resuscitation.2017.04.003.
33. Swor R.A., Jackson R.E., Compton S., Domeier R., Zalenski R., Honeycutt L., Kuhn G.J., Frederiksen S., Pascual R.G. Cardiac arrest in private locations: Different strategies are needed to improve outcome. Resuscitation. 2003;58:171–176. doi: 10.1016/S0300-9572(03)00118-7.
34. Chiang W.C., Chen S.Y., Ko P.C., Hsieh M.J., Wang H.C., Huang E.P.C., Yang C.W., Chong K.M., Chen W.T., Chen S.Y., et al. Prehospital intravenous epinephrine may boost survival of patients with traumatic cardiac arrest: A retrospective cohort study. Scand. J. Trauma Resusc. Emerg. Med. 2015;23:102. doi: 10.1186/s13049-015-0181-4.
35. Wang C.H., Chou N.K., Becker L.B., Lin J.W., Yu H.Y., Chi N.H., Hunag S.C., Ko W.J., Wang S.S., Tseng L.J., et al. Improved outcome of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest—A comparison with that for extracorporeal rescue for in-hospital cardiac arrest. Resuscitation. 2014;85:1219–1224. doi: 10.1016/j.resuscitation.2014.06.022.
36. Nolan J.P., Soar J., Cariou A., Cronberg T., Moulaert V.R., Deakin C.D., Bottiger B.W., Friberg H., Sunde K., Sandroni C. European Resuscitation Council and European Society of Intensive Care Medicine 2015 guidelines for post-resuscitation care. Intensive Care Med. 2015;41:2039–2056. doi: 10.1007/s00134-015-4051-3.
37. Dyson K., Bray J.E., Smith K., Bernard S., Straney L., Finn J. Paramedic Exposure to Out-of-Hospital Cardiac Arrest Resuscitation Is Associated With Patient Survival. Circ. Cardiovasc. Qual. Outcomes. 2016;9:154–160. doi: 10.1161/CIRCOUTCOMES.115.002317.
38. Tuttle J.E., Hubble M.W. Paramedic Out-of-hospital Cardiac Arrest Case Volume Is a Predictor of Return of Spontaneous Circulation. West J. Emerg. Med. 2018;19:654–659. doi: 10.5811/westjem.2018.3.37051.
39. Lin C.H., Ng Y.Y., Chiang W.C., Karim S.A., Shin S.D., Tanaka H., Nishiuchi T., Kajino K., Khunkhlai N., Ma M.H., et al. Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries. J. Formos. Med. Assoc. 2016;115:628–638. doi: 10.1016/j.jfma.2015.10.003.
40. Lu C.H., Fang P.H., Lin C.H. Dispatcher-assisted cardiopulmonary resuscitation for traumatic patients with out-of-hospital cardiac arrest. Scand. J. Trauma Resusc. Emerg. Med. 2019;27:97. doi: 10.1186/s13049-019-0679-2.
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Mohammd Mashi Genef Alanze . Eid Farhan Naif Al Anazi . Mshari Madhor Fawaz Aldahmashi Majd Hazza Matab Bn Bseais . Shaker Mater Hazzaa Alshammari . Nasser Rashid Abdulaziz Al-Mutairi. (2022). Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 818-824. https://doi.org/10.53555/jptcp.v29i04.5548
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How to Cite
Mohammd Mashi Genef Alanze . Eid Farhan Naif Al Anazi . Mshari Madhor Fawaz Aldahmashi Majd Hazza Matab Bn Bseais . Shaker Mater Hazzaa Alshammari . Nasser Rashid Abdulaziz Al-Mutairi. (2022). Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 818-824. https://doi.org/10.53555/jptcp.v29i04.5548