Abstract
Background In South Korea, the prehospital treatment of cardiac arrest is generally led by an emergency medical technician-paramedic (EMT-P), and defibrillation is delivered by the automatic external defibrillator (AED). This study aimed at examining the effects of direct medical guidance by an emergency physician through a video call that enabled prompt manual defibrillation. Methods Two-hundred eighty-eight paramedics based in Gyeonggi Province were studied for four months, from July to November 2015. The participants were divided into 96 teams, and the teams were randomly divided into either a conventional group that was to use the AED or a video call guidance group which was to use the manual defibrillators, with 48 teams in each group. The time to first defibrillation, total hands-off time, and hands-off ratio were compared between the two groups. Results The median value of the time to the first defibrillation was significantly shorter in the video call guidance group (56 s) than in the conventional group (73 s) (p<0.001). The median value of the total hands-off time was also significantly shorter (228 vs. 285.5 s) (p<0.001), and the hands-off ratio, defined as the proportion of hands-off time out of the total CPR time, was significantly shorter in the video call guidance group (0.32 vs. 0.41) (p<0.001). Conclusion Physician-guided CPR with a video call enabled prompt manual defibrillation and significantly shortened the time required for first defibrillation, hands-off time, and hands-off ratio in simulated cases of prehospital cardiac arrest.
Highlights
In South Korea, the rates of restoration of spontaneous circulation (ROSC) following cardiac arrest in 2012-2015 were 5.1% and 23.1% before and after hospital arrival, respectively, while the rate of survival to hospital discharge among patients who were hospitalized after the acute cardiac arrest was merely 5.0% [1]
In South Korea, as physicians are not staffed in 119ambulances, the prehospital treatment is generally led by an emergency medical technician-paramedic (EMT-P) and manual defibrillator use, advanced airway insert, and intravenous line placement are not allowed to emergency medical technicianparamedic (EMT-P) without the physician’s direct medical control in point of law
The participants were divided into 96 teams of one EMT-P leader and two team members, and the teams were randomly divided into either a group using the automatic external defibrillator (AED) or a group using manual defibrillators with video guidance by a physician, with 48 teams in each group (Figure 1)
Summary
In South Korea, the rates of restoration of spontaneous circulation (ROSC) following cardiac arrest in 2012-2015 were 5.1% and 23.1% before and after hospital arrival, respectively, while the rate of survival to hospital discharge among patients who were hospitalized after the acute cardiac arrest was merely 5.0% [1]. The proportion of patients who were discharged with the good neurological outcome (cerebral performance categories 1, 2), which is the final resuscitation goal for out-of-hospital cardiac arrest patients, was only 2.3% This is an extremely low rate compared to the rate of 6.9% reported in the U.S nationwide CARES study from 2005 to 2010 and 8.9% reported in a Japanese study conducted in Osaka from 2007 to 2009 [2, 3]. This study aimed at examining the effects of direct medical guidance by an emergency physician through a video call that enabled prompt manual defibrillation. Physician-guided CPR with a video call enabled prompt manual defibrillation and significantly shortened the time required for first defibrillation, hands-off time, and hands-off ratio in simulated cases of prehospital cardiac arrest
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