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Jung E, Ryu HH, Ro YS, Shin SD. Association between post-cardiac arrest treatments and clinical outcomes according to scene time interval in out-of-hospital cardiac arrest: Retrospective cross-sectional study. Am J Emerg Med 2023; 72:27-33. [PMID: 37467557 DOI: 10.1016/j.ajem.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/24/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Previous studies have reported that Post-Cardiac arrest (PCA) treatments including targeted temperature management (TTM), coronary reperfusion therapy (CRT), and extracorporeal membrane oxygenation (ECMO) are time-sensitive; however, there are no reports of the clinical outcomes of PCA treatment according to the scene time interval (STI). Our study aimed to investigated the clinical outcomes of PCA treatment according to the STI. METHODS We used a Korean nationwide OHCA cohort database from January 2017 to December 2020. The inclusion criteria were all adult OHCA patients with a presumed cardiac etiology, bystander-witnessed arrest, and prehospital return of spontaneous circulation (ROSC). The outcomes were survival to discharge and good neurological recovery. The main exposure of interest was PCA treatment. We compared the outcomes using multivariable logistic regression, and interaction terms were included in the final model to assess whether the STI modified the effect of PCA treatment on clinical outcomes of OHCA. RESULTS TTM and CRT were associated with high survival to discharge and good neurological recovery. In the interaction analysis, ECMO had an interaction effect with the STI on a good CPC among patients with OHCA [short STI (0 to 11 min) (1.16 (0.77-1.75)), middle STI (12 to 15 min) (0.66 (0.41-1.06)), and long STI (16 to 30 min) (0.59 (0.40-0.88)) (p for interaction <0.05)]. CONCLUSION In adult bystander-witnessed patients with OHCA with prehospital ROSC, an STI of >16 min was a risk factor for poor neurological outcome in those patients who underwent ECMO.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Medicine, Chonnam National University, Gwangju, Republic of Korea.
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University hospital, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University, Seoul, Republic of Korea
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Primi R, Bendotti S, Currao A, Sechi GM, Marconi G, Pamploni G, Panni G, Sgotti D, Zorzi E, Cazzaniga M, Piccolo U, Bussi D, Ruggeri S, Facchin F, Soffiato E, Ronchi V, Contri E, Centineo P, Reali F, Sfolcini L, Gentile FR, Baldi E, Compagnoni S, Quilico F, Vicini Scajola L, Lopiano C, Fasolino A, Savastano S. Use of Mechanical Chest Compression for Resuscitation in Out-Of-Hospital Cardiac Arrest-Device Matters: A Propensity-Score-Based Match Analysis. J Clin Med 2023; 12:4429. [PMID: 37445464 DOI: 10.3390/jcm12134429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Devices for mechanical cardiopulmonary resuscitation (CPR) are recommended when high quality CPR cannot be provided. Different devices are available, but the literature is poor in direct comparison studies. Our aim was to assess whether the type of mechanical chest compressor could affect the probability of return of spontaneous circulation (ROSC) and 30-day survival in Out-of-Hospital Cardiac Arrest (OHCA) patients as compared to manual standard CPR. METHODS We considered all OHCAs that occurred from 1 January 2015 to 31 December 2022 in seven provinces of the Lombardy region equipped with three different types of mechanical compressor: Autopulse®(ZOLL Medical, MA), LUCAS® (Stryker, MI), and Easy Pulse® (Schiller, Switzerland). RESULTS Two groups, 2146 patients each (manual and mechanical CPR), were identified by propensity-score-based random matching. The rates of ROSC (15% vs. 23%, p < 0.001) and 30-day survival (6% vs. 14%, p < 0.001) were lower in the mechanical CPR group. After correction for confounders, Autopulse® [OR 2.1, 95%CI (1.6-2.8), p < 0.001] and LUCAS® [OR 2.5, 95%CI (1.7-3.6), p < 0.001] significantly increased the probability of ROSC, and Autopulse® significantly increased the probability of 30-day survival compared to manual CPR [HR 0.9, 95%CI (0.8-0.9), p = 0.005]. CONCLUSION Mechanical chest compressors could increase the rate of ROSC, especially in case of prolonged resuscitation. The devices were dissimilar, and their different performances could significantly influence patient outcomes. The load-distributing-band device was the only mechanical chest able to favorably affect 30-day survival.
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Affiliation(s)
- Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, 27100 Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Gianluca Marconi
- Agenzia Regionale dell'Emergenza Urgenza (AREU) Lombardia, 20124 Milan, Italy
| | - Greta Pamploni
- AAT Pavia-Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Gianluca Panni
- AAT Brescia-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Degli Spedali Civili di Brescia, 25100 Brescia, Italy
| | - Davide Sgotti
- AAT Brescia-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Degli Spedali Civili di Brescia, 25100 Brescia, Italy
| | - Ettore Zorzi
- AAT Como-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Lariana (CO), 22079 Como, Italy
| | - Marco Cazzaniga
- AAT Como-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Lariana (CO), 22079 Como, Italy
| | - Umberto Piccolo
- AAT Como-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Lariana (CO), 22079 Como, Italy
| | - Daniele Bussi
- AAT Cremona-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, 26100 Cremona, Italy
| | - Simone Ruggeri
- AAT Cremona-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, 26100 Cremona, Italy
| | - Fabio Facchin
- AAT Mantova-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantova, 46100 Mantova, Italy
| | - Edoardo Soffiato
- AAT Mantova-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantova, 46100 Mantova, Italy
| | - Vincenza Ronchi
- AAT Pavia-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST Pavia, 27100 Pavia, Italy
| | - Enrico Contri
- AAT Pavia-Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paola Centineo
- AAT Varese-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST dei Sette Laghi, 21100 Varese, Italy
| | - Francesca Reali
- AAT Lodi-Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Lodi, 26900 Lodi, Italy
| | - Luigi Sfolcini
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Federico Quilico
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Luca Vicini Scajola
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Clara Lopiano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Alessandro Fasolino
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Sun M, Zhu A, Tang Y. Continuous compression with asynchronous ventilation improves CPR prognosis? A meta-analysis from human and animal studies. Am J Emerg Med 2023; 64:26-36. [PMID: 36435007 DOI: 10.1016/j.ajem.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The cardiopulmonary resuscitation (CPR) compression to ventilation strategy remains controversial. We conducted a meta-analysis to compare the outcomes between continuous chest compressions CPR with asynchronous ventilation (CCC-CPR) and interrupted chest compressions CPR with synchronous ventilation (ICC-CPR) in cardiac arrest. METHODS PubMed, Web of Science, Embase, MEDLINE (Ovid/LWW) and the Cochrane Libraries were searched up from inception to July 31, 2022. Human and animal studies comparing CCC-CPR versus ICC-CPR were included. Outcome variables were return of spontaneous circulation (ROSC), time to ROSC, survival to discharge, 1-month survival, survival at 4 h, good neurological function, mean arterial pressure (MAP) and other clinical parameters. Jadad Scale and Newcastle-Ottawa Scale were used to assess the study quality and risk of bias. RESULTS The systematic search identified eight studies on humans and twelve studies on animal trials. There were no significant differences in ROSC (odd ratios [OR] 1.07; 95% confidence interval [CI]: 0.86-1.32; P = 0.55), survival to hospital discharge (OR 1.04; 95%CI 0.77-1.42; P = 0.79), 1-month survival (OR 1.07; 95%CI 0.84-1.36; P = 0.57), and good neurological outcome (OR 0.92; 95%CI 0.84-1.01, P = 0.09) between CCC-CPR and ICC-CPR in human studies. In animal trials, CCC-CPR had significantly higher rate of ROSC (OR = 1.81; 95% CI: 0.94-3.49; P = 0.07), survival at 4 h (OR 2.57; 95% CI: 1.16-5.72; P = 0.02) and MAP (mean difference [MD] 0.79, 95% CI: 0.04-1.53; P = 0.04), even though no significant differences in ROSC time, arterial potential of hydrogen (pH) and partial tension of carbon dioxide (PaCO2). CONCLUSION CCC-CPR did not show superiority in human outcomes compared with ICC-CPR, but its effect value was significantly increased in animal experiments. We should take the positive outcomes from animals and apply them to human models, and more physiological mechanisms need to be confirmed in CPR patients with different compression-ventilation strategies to improve the prognosis of cardiac arrest.
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Affiliation(s)
- Mengxue Sun
- Xiangya Nursing School of Central South University, Changsha, Hunan, China; Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Aiqun Zhu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Emergency Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Yangyang Tang
- Xiangya Nursing School of Central South University, Changsha, Hunan, China; Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Jung E, Ro YS, Ryu HH, Shin SD. Association of prehospital airway management technique with survival outcomes of out-of-hospital cardiac arrest patients. PLoS One 2022; 17:e0269599. [PMID: 35666760 PMCID: PMC9170082 DOI: 10.1371/journal.pone.0269599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/24/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Despite numerous studies on airway management in out-of-hospital cardiac arrest (OHCA) patients, the choice of prehospital airway management technique remains controversial. Our study aimed to investigate the association between prehospital advanced airway management and survival outcomes according to a transport time interval (TTI) using nationwide OHCA registry database in Korea. Methods The inclusion criteria were patients with OHCA aged over 18 years old with a presumed cardiac etiology between January 2015 and December 2018. The primary outcome was survival to hospital discharge. The main exposure was the prehospital airway management technique performed by the emergency medical technicians (EMTs), classified as bag-valve mask (BVM), supraglottic airway (SGA), or endotracheal intubation (ETI).We performed multivariable logistic regression analysis and interaction analysis between the type of airway management and TTI for adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results Of a total of 70,530 eligible OHCA patients, 26,547 (37.6%), 38,391 (54.4%), and 5,592 (7.9%) were managed with BVM, SGA, ETI, respectively. Patients in the SGA and ETI groups had a higher odds of survival to discharge than BVM groups (aOR, 1.11 (1.05–1.16) and 1.13 (1.05–1.23)). And the rates of survival to discharge with SGA and ETI were significantly higher in groups with TTI more than 8 minutes (1.17 (1.08–1.27) and 1.38 (1.20–1.59)). Conclusion The survival to discharge was significantly higher among patients who received ETI and SGA than in those who received BVM. The transport time interval influenced the effect of prehospital airway management on the clinical outcomes after OHCA.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- Chonnam National University College of Medicine, Gwangju, Republic of Korea
- * E-mail:
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Comparison between Prehospital Mechanical Cardiopulmonary Resuscitation (CPR) Devices and Manual CPR for Out-of-Hospital Cardiac Arrest: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis. J Clin Med 2022; 11:jcm11051448. [PMID: 35268537 PMCID: PMC8911115 DOI: 10.3390/jcm11051448] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
In pre-hospital settings, efficient cardiopulmonary resuscitation (CPR) is challenging; therefore, the application of mechanical CPR devices continues to increase. However, the evidence of the benefits of using mechanical CPR devices in pre-hospital settings for adult out-of-hospital cardiac arrest (OHCA) is controversial. This meta-analysis compared the effects of mechanical and manual CPR applied in the pre-hospital stage on clinical outcomes after OHCA. Cochrane Library, PubMed, Embase, and ClinicalTrials.gov were searched from inception until October 2021. Studies comparing mechanical and manual CPR applied in the pre-hospital stage for survival outcomes of adult OHCA were eligible. Data abstraction, quality assessment, meta-analysis, trial sequential analysis (TSA), and grading of recommendations, assessment, development, and evaluation were conducted. Seven randomized controlled and 15 observational studies were included. Compared to manual CPR, pre-hospital use of mechanical CPR showed a positive effect in achieving return of spontaneous circulation (ROSC) and survival to admission. No difference was found in survival to discharge and discharge with favorable neurological status, with inconclusive results in TSA. In conclusion, pre-hospital use of mechanical CPR devices may benefit adult OHCA in achieving ROSC and survival to admission. With low certainty of evidence, more well-designed large-scale randomized controlled trials are needed to validate these findings.
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Apiratwarakul K, Celebi I, Tiamkao S, Bhudhisawasdi V, Pearkao C, Ienghong K. Understanding of Development Emergency Medical Services in Laos Emergency Medicine Residents. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Rising death tolls from traffic accidents are quickly becoming an inescapable problem in almost all countries around the world. That being said, the World Health Organization has launched an ambitious campaign aimed at reducing the death rate from traffic accidents by 50% in the next 10 years. Development of emergency medical services (EMSs) was the tool to success the goals, especially in low- to middle-income countries including Laos. However, no studies regard perspective of training EMS in Laos emergency medicine residents.
AIM: The aim of our work is to demonstrate the effect of EMS training for Laos emergency medicine residents to the development of the national policy in Lao’s EMS.
METHODS: A cross-sectional study was conducted in two countries (Laos and Thailand) from January 2020. The project activities were establishment of a command-and-control center, development of EMS support system, and training for emergency care professionals.
RESULTS: The eight Laos emergency medicine residents were enrolled between January and March 2020. After practicing as a dispatcher and emergency medical consultant in Thailand at Khon Kaen University, the participants from Laos found that all personnel gained experience and improved their knowledge of technology in EMS and organization management. This had a direct impact on improving confidence in their return to practice in Laos.
CONCLUSIONS: The human resource development through international collaboration between Thailand and Laos is contributing the effective knowledge and expertise learning in Laos. Moreover, the result of this training may provide the most effective care system resulting in the much-needed drop in the mortality rate of traffic accidents in Laos.
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Lim D, Park SY, Choi B, Kim SH, Ryu JH, Kim YH, Sung AJ, Bae BK, Kim HB. The Comparison of Emergency Medical Service Responses to and Outcomes of Out-of-hospital Cardiac Arrest before and during the COVID-19 Pandemic in an Area of Korea. J Korean Med Sci 2021; 36:e255. [PMID: 34519188 PMCID: PMC8438185 DOI: 10.3346/jkms.2021.36.e255] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/29/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 has affected the responses of emergency medical service (EMS) systems to cases of out-of-hospital cardiac arrest (OHCA). The purpose of this study was to identify the impact of the COVID-19 pandemic on EMS responses to and outcomes of adult OHCA in an area of South Korea. METHODS This was a retrospective observational study of adult OHCA patients attended by EMS providers comparing the EMS responses to and outcomes of adult OHCA during the COVID-19 pandemic to those during the pre-COVID-19 period. Propensity score matching was used to compare the survival rates, and logistic regression analysis was used to assess the impact of the COVID-19 pandemic on the survival of OHCA patients. RESULTS A total of 891 patients in the pre-COVID-19 group and 1,063 patients in the COVID-19 group were included in the final analysis. During the COVID-19 period, the EMS call time was shifted to a later time period (16:00-24:00, P < 0.001), and the presence of an initial shockable rhythm was increased (pre-COVID-19 vs. COVID-19, 7.97% vs. 11.95%, P = 0.004). The number of tracheal intubations decreased (5.27% vs. 1.22%, P < 0.001), and the use of mechanical chest compression devices (30.53% vs. 44.59%, P < 0.001) and EMS response time (median [quartile 1-quartile 3], 7 [5-10] vs. 8 [6-11], P < 0.001) increased. After propensity score matching, the survival at admission rate (22.52% vs. 18.24%, P = 0.025), survival to discharge rate (7.77% vs. 5.52%, P = 0.056), and favorable neurological outcome (5.97% vs. 3.49%, P < 0.001) decreased. In the propensity score matching analysis of the impact of COVID-19, odds ratios of 0.768 (95% confidence interval [CI], 0.592-0.995) for survival at admission and 0.693 (95% CI, 0.446-1.077) for survival to discharge were found. CONCLUSION During the COVID-19 period, there were significant changes in the EMS responses to OHCA. These changes are considered to be partly due to social distancing measures. As a result, the proportion of patients with an initial shockable rhythm in the COVID-19 period was greater than that in the pre-COVID-19 period, but the final survival rate and favorable neurological outcome were lower.
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Affiliation(s)
- Daesung Lim
- Department of Emergency Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Song Yi Park
- Department of Emergency Medicine, Dong-A University College of Medicine, Dong-A University Hospital, Busan, Korea.
| | - Byungho Choi
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Ji Ho Ryu
- Department of Emergency Medicine, Pusan National University College of Medicine, Pusan National University Yangsan Hospital, Busan, Korea
| | - Yong Hwan Kim
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ae Jin Sung
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Byung Kwan Bae
- Department of Emergency Medicine, Pusan National University College of Medicine, Pusan National University Hospital, Busan, Korea
| | - Han Byeol Kim
- Department of Emergency Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
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Jung E, Ro YS, Ryu HH, Shin SD, Moon S. Interaction Effects between COVID-19 Outbreak and Community Income Levels on Excess Mortality among Patients Visiting Emergency Departments. J Korean Med Sci 2021; 36:e100. [PMID: 33821595 PMCID: PMC8021976 DOI: 10.3346/jkms.2021.36.e100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/25/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The objective of this study was to examine the effect of the coronavirus disease 2019 (COVID-19) outbreak on excess in-hospital mortality among patients who visited emergency departments (EDs) and to assess whether the excess mortality during the COVID-19 pandemic varies by community income level. METHODS This is a cross-sectional study using the National Emergency Department Information System (NEDIS) database in Korea. The study population was defined as patients who visited all 402 EDs with medical conditions other than injuries between January 27 and May 31, 2020 (after-COVID) and for the corresponding time period in 2019 (before-COVID). The primary outcome was in-hospital mortality. The main exposure was the COVID-19 outbreak, and the interaction variable was county per capita income tax. We calculated the risk-adjusted in-hospital mortality rates by COVID-19 outbreak, as well as the difference-in-difference of risk-adjusted rates between the before-COVID and after-COVID groups according to the county income tax using a multilevel linear regression model with the interaction term. RESULTS A total of 11,662,167 patients (6,765,717 in before-COVID and 4,896,450 in after-COVID) were included in the study with a 1.6% crude in-hospital mortality rate. The risk-adjusted mortality rate in the after-COVID group was higher than that in the before-COVID group (1.82% vs. 1.50%, difference: 0.31% [0.30 to 0.33]; adjusted odds ratio: 1.22 [1.18 to 1.25]). The excess in-hospital mortality rate of the after-COVID in the lowest quartile group of county income tax was significantly higher than that in the highest quartile group (difference-in-difference: 0.18% (0.14 to 0.23); P-for-interaction: < 0.01). CONCLUSION During the COVID-19 pandemic, there was excess in-hospital mortality among patients who visited EDs, and there were disparities in excess mortality depending on community socioeconomic positions.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Sun Ro
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sungwoo Moon
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
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