Abstract 152: Dispatching Emergency Life-Saving Technician Improves Neurological Outcome 1-Month After Out-of-Hospital Cardiac Arrest Independently of Their Advanced Life Support Procedures
Background: In Japan, Emergency Life-Saving Technicians (ELSTs) are permitted to place peripheral intravenous catheters, advanced airway devices (esophageal obturator airways, laryngeal mask), and to use automated external defibrillators. Some are additionally qualified for endotracheal intubation and epinephrine use. Recent studies have shown, however, that prehospital epinephrine use was significantly associated with poor functional outcome after out-of-hospital cardiac arrest (OHCA). We assessed the hypothesis that having ELSTs on board would still have a favorable effect on neurological outcome after cardiogenic OHCA.
Methods: Data on all cardiogenic OHCA patients, witnessed by any dispatched emergency service member were extracted from the nationwide, Utstein-style registry (April 2006 - December 2010). The main outcome measure was survival with favorable neurological outcome, defined as Cerebral Performance Category (CPC) 1 or 2, at one month after OHCA. To determine the effect of having ELSTs dispatched, we performed multiple logistic regression analyses, adjusting for factors known to potentially affect the outcome, such as age, gender, location, intravenous cannulation, advanced airway device and epinephrine use.
Result: Out of 525,632 cases registered, 9,580 adult cardiogenic OHCA cases, witnessed by any emergency service member, without physicians either on board or performing advanced life support procedures, were identified. Advanced airway device use had a significantly negative effect (adjusted OR 0.199; 95%CI 0.154-0.256) on CPC-1 or 2 survival, and so did epinephrine use (adjusted OR 0.236; 95%CI 0.115-0.485), while intravenous cannulation did not have significant influence(adjusted OR 0.710; 95%CI 0.504-1.001). The dispatch of ELSTs showed significantly better CPC-1 or 2 survival, with an adjusted OR of 2.037 (95%CI 1.480-2.804).
Conclusion: Dispatching ELSTs has a positive effect on the neurological outcome of cardiogenic OHCA patients, independent of advanced life support procedures undertaken by ELSTs. Effective basic life support including high-quality chest compression/bag-mask ventilation, information-gathering and decision-making performed by trained ELSTs could be contributing factors.
- © 2013 by American Heart Association, Inc.