Factors Associated with Successful Resuscitation during Out-of-Hospital Cardiac Arrest Performed By Surgico Medical Ambulance and Rescue Team (S.M.A.R.T), Division of Emergency Medical Service and Disaster, Faculty of Medicine Vajira Hospital, Navamindrad

Objective: To explore factors associated with successful on-scene cardiac resuscitation and to identify the number of patients with return of spontaneous circulation (ROSC). Materials and Methods: The present study was a retrospective descriptive study. Data were collected from the Surgico Medical Ambulance and Rescue Team at the Emergency Medicine Service and Disaster Division, Navamindradhiraj University. Data were recorded by using the overall operation reports of the Bangkok Emergency Medical Service Centre (Erawan Centre) about advanced life support. The reports used the code followed by the Emergency Medical Triage Protocol and Criteria Based Dispatch (CBD), CBD6 Red1, or followed by Response Code (RC) RC6 Red1, between May 2019 and April 2020. Results: Two hundred seventy-three patients with out-of-hospital cardiac arrest (OHCA) were included in the present study. Seventy (25.6%) patients were successfully on-scene resuscitated, of which, 65.7% were male patients with an average age of 57.87 (standard deviation [SD] 21.6) years. However, 203 (74.4%) patients that received appropriated advanced resuscitation (non-ROSC) died on scene. Among patients in the successful resuscitation group and those in the deceased group, 65.7% and 61.6% were male, respectively (p=0.537). The mean age was 57.87 (SD 21.6) years and 65.8 (SD 20.21) years, respectively (p=0.006). In the multivariate analysis controlled for confounders, a significant association (p<0.05) was found between successful pre-hospital cardiac resuscitation on scene with the following four factors, traumatic cardiac arrest (adjusted odds ratio [OR] 4.18, 95% confidence interval [CI] 1.60 to 10.93, p=0.004), response time within eight minutes (adjusted OR 2.07, 95% CI 1.03 to 4.14, p=0.041), initial electrocardiogram with ventricular fibrillation (adjusted OR 2.63, 95% CI 1.13 to 6.12, p=0.025, and pulseless electrical activity (adjusted OR 2.89, 95% CI 1.26 to 6.64, p=0.012), and administration of resuscitation drug with epinephrine (adjusted OR 13.62, 95% CI 4.72 to 39.31, p<0.001). Conclusion: In the present study, four factors were found to have a significant association with successful prehospital cardiac resuscitation on scene. Based on the knowledge discovered, these factors will develop on-scene CPR guidelines for the care of patients with OHCA for the authors’ emergency medical service personals. Keywords: Success; Resuscitation; Prehospital cardiac arrest

MP55: Reducing barriers to successful cardiac resuscitation: intervention in elementary schools

Introduction: The incidence of out-of-hospital cardiac arrest (OHCA) in school is approximately 2.1 for 100,000 per year. Although rare, it is a devastating event for the local community. Schools with public access to automated external defibrillators (AED) and an emergency response plan have demonstrated increased survival rates of up to 70% for students who suffer cardiac arrest. Previous studies identified numerous barriers to successful cardiac resuscitation in public school systems. The main objectives of this study were to identify those barriers in the Quebec region elementary school system and to assess the impacts of an AED focused training session. Methods: A previously validated survey focused on the potential barriers to successful defibrillation in OHCA and on demographic variables was sent to 139 elementary schools. Later, 92 employees within three elementary schools who responded to the survey were evaluated before and after receiving training on the use of AED in a mock cardiac arrest scenario. The primary outcome was the time to first shock and the secondary outcomes included correct AED pad placement and safety of the procedure. Results: Survey response rate was 53%, which is comparable to previous studies assaying barriers to cardiac resuscitation in public school systems. 95% of school respondents reported the presence of an AED on the school premises but 46% stated that no formal AED training course was provided to employees. Out of the four schools who reported a previous OHCA, only one had access to an AED at the time of the event. Following focused AED training, 92% of school workers successfully completed a defibrillation sequence in a mock scenario, from 53% before (p < 0.001, McNemar test). The time to first shock went from 66 seconds (95% CI 63-70) to 47 seconds (95% CI 45-49; -29%, p < 0.001). Proper pad placement was the most problematic step for participants and personnel who reported previous training had better performance (OR 3.15, 95% CI 1.33-7.42, p = 0.009). Conclusion: Most elementary schools in the Quebec region have access to AEDs. However, inadequate AED training represents a significant barrier to successful defibrillation in the event of an OHCA. Our results showed that a simple focused AED training could improve the performance of school workers and optimize the chain of survival.