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Xuan Dao C, Quoc Luong C, Manabe T, Ha Nguyen M, Thi Pham D, Thanh Ton T, Ai Hoang QT, Anh Nguyen T, Dat Nguyen A, Francis McNally B, Hock Ong ME, Ngoc Do S. Impact of Bystander Cardiopulmonary Resuscitation on Out-of-Hospital Cardiac Arrest Outcome in Vietnam. West J Emerg Med 2024; 25:507-520. [PMID: 39028237 PMCID: PMC11254151 DOI: 10.5811/westjem.18413] [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: 09/08/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Patients experiencing an out-of-hospital cardiac arrest (OHCA) frequently do not receive bystander cardiopulmonary resuscitation (CPR), especially in low- and middle-income countries (LMIC). In this study we sought to determine the prevalence of OHCA patients in Vietnam who received bystander CPR and its effects on survival outcomes. Methods We performed a multicenter, retrospective observational study of patients (≥18 years) presenting with OHCA at three major hospitals in an LMIC from February 2014-December 2018. We collected data on the hospital and patient characteristics, the cardiac arrest events, the emergency medical services (EMS) system, the therapy methods, and the outcomes and compared these data, before and after pairwise 1:1 propensity score matching, between patients who received bystander CPR and those who did not. Upon admission, we assessed factors associated with good neurological survival at hospital discharge in univariable and multivariable logistic models. Results Of 521 patients, 388 (74.5%) were men, and the mean age was 56.7 years (SD 17.3). Although most cardiac arrests (68.7%, 358/521) occurred at home and 78.8% (410/520) were witnessed, a low proportion (22.1%, 115/521) of these patients received bystander CPR. Only half of the patients were brought by EMS (8.1%, 42/521) or private ambulance (42.8%, 223/521), 50.8% (133/262) of whom had resuscitation attempts. Before matching, there was a significant difference in good neurological survival between patients who received bystander CPR (12.2%, 14/115) and patients who did not (4.7%, 19/406; P < .001). After matching, good neurological survival was absent in all OHCA patients who did not receive CPR from a bystander. The multivariable analysis showed that bystander CPR (adjusted odds ratio: 3.624; 95% confidence interval 1.629-8.063) was an independent predictor of good neurological survival. Conclusion In our study, only 22.1% of total OHCA patients received bystander CPR, which contributed significantly to a low rate of good neurological survival in Vietnam. To improve the chances of survival with good neurological functions of OHCA patients, more people should be trained to perform bystander CPR and teach others as well. A standard program for emergency first-aid training is necessary for this purpose.
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Affiliation(s)
- Co Xuan Dao
- Bach Mai Hospital, Center for Critical Care Medicine, Hanoi, Vietnam
- Hanoi Medical University, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam
- Vietnam National University, University of Medicine and Pharmacy, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam
| | - Chinh Quoc Luong
- Hanoi Medical University, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam
- Vietnam National University, University of Medicine and Pharmacy, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam
- Bach Mai Hospital, Center for Emergency Medicine, Hanoi, Vietnam
| | - Toshie Manabe
- Nagoya City University Graduate School of Medicine, Department of Medical Innovation, Nagoya, Aichi, Japan
- Nagoya City University West Medical Center, Center for Clinical Research, Nagoya, Aichi, Japan
| | - My Ha Nguyen
- Thai Binh University of Medicine and Pharmacy, Department of Health Organization and Management, Thai Binh, Vietnam
| | - Dung Thi Pham
- Thai Binh University of Medicine and Pharmacy, Department of Nutrition and Food Safety, Thai Binh, Vietnam
| | - Tra Thanh Ton
- Cho Ray Hospital, Emergency Department, Ho Chi Minh City, Vietnam
| | - Quoc Trong Ai Hoang
- Hue Central General Hospital, Emergency Department, Hue City, Thua Thien Hue, Vietnam
| | - Tuan Anh Nguyen
- Hanoi Medical University, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam
- Bach Mai Hospital, Center for Emergency Medicine, Hanoi, Vietnam
| | - Anh Dat Nguyen
- Hanoi Medical University, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam
- Bach Mai Hospital, Center for Emergency Medicine, Hanoi, Vietnam
| | - Bryan Francis McNally
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Marcus Eng Hock Ong
- Singapore General Hospital, Department of Emergency Medicine, Singapore, Singapore
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore
| | - Son Ngoc Do
- Bach Mai Hospital, Center for Critical Care Medicine, Hanoi, Vietnam
- Hanoi Medical University, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam
- Vietnam National University, University of Medicine and Pharmacy, Department of Emergency and Critical Care Medicine, Hanoi, Vietnam
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Ko Y, Hsieh M, Cheng A, Lauridsen KG, Sawyer TL, Bhanji F, Greif R. Faculty Development Approaches for Life Support Courses: A Scoping Review. J Am Heart Assoc 2022; 11:e025661. [PMID: 35656992 PMCID: PMC9238697 DOI: 10.1161/jaha.122.025661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
Abstract
The aim of this scoping review initiated by the Education, Implementation and Teams Task Force of the International Liaison Committee on Resuscitation was to identify faculty development approaches to improve instructional competence in accredited life support courses. We searched PubMed, Ovid Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials to identify studies published from January 1, 1966 to December 31, 2021 on approaches to improve faculty development for life support courses. Data on participant characteristics, interventions, design, and outcomes of included studies were extracted. Of the initially identified 10 310 studies, we included 20 studies (5 conference abstracts, 1 short communication, 14 full-length articles). Among them, 12 studies aimed to improve instructors/candidates' teaching ability in basic life support courses. A wide variety of interventions were identified. The interventions were categorized into 4 themes: instructor qualification/training (n=9), assessment tools (n=3), teaching skills enhancement (n=3), and additional courses for instructors (n=5). Most studies showed that these interventions improved specific teaching ability or confidence of the instructors and learning outcomes in different kinds of life support courses. However, no studies addressed clinical outcomes of patients. In conclusion, the faculty development approaches for instructors are generally associated with improved learning outcomes for participants, and also improved teaching ability and self-confidence of the instructors. It is encouraged that local organizations implement faculty development programs for their teaching staff of their accredited resuscitation courses. Further studies should explore the best ways to strengthen and maintain instructor competency, and define the cost-effectiveness of various different faculty development strategies.
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Affiliation(s)
- Ying‐Chih Ko
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Ming‐Ju Hsieh
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Adam Cheng
- Departments of Pediatrics and Emergency MedicineUniversity of CalgaryAlbertaCanada
| | - Kasper G. Lauridsen
- Research Center for Emergency MedicineAarhus University HospitalAarhusDenmark
- Emergency DepartmentRanders Regional HospitalRandersDenmark
- Department of Anesthesiology and Critical Care MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPA
| | - Taylor L. Sawyer
- University of Washington School of MedicineSeattleWA
- Seattle Children’s HospitalSeattleWA
| | - Farhan Bhanji
- Department of PediatricsMcGill UniversityMontrealCanada
| | - Robert Greif
- Department of Anaesthesiology and Pain MedicineBern University HospitalUniversity of BernBernSwitzerland
- School of MedicineSigmund Freud University ViennaViennaAustria
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Nguyen BU, Holterman A, Holterman M, Dinh LT. Academic Pediatric Surgery Capacity Building in Vietnam Through PASS, a Pediatric Acute Surgical Support Course. Front Surg 2022; 9:868483. [PMID: 35529908 PMCID: PMC9069233 DOI: 10.3389/fsurg.2022.868483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/04/2022] [Indexed: 01/06/2023] Open
Abstract
Neonatal and pediatric surgical emergencies in Low and Low Middle Income countries remain a significant challenge in combatting the burden and inequities of global health. IPSAC-Vietnam is a small Non-Governmental Organization that has been engaged in a 12-year multi-pronged partnership with several children’s hospitals in Vietnam VN to enhance pediatric surgery capacity. We describe the health care, medical training and emergency system in VN as the background for IPSAC activities and development of Pediatric Acute Surgical Support (PASS) course. The course goal is to prepare health care personnel in the immediate management of neonatal/pediatric life-threatening surgical conditions and road injuries at their first point of entry into Vietnam hospitals. PASS is a horizontal outreach initiative that adopts an interprofessional, multidisciplinary, team-training, train-the-trainers, and outcome-based training approach. PASS can be used as a tool for sustainable horizontal capacity-building by champion leaders at the teaching children’s hospitals and medical universities in developing countries, to strengthen training for pediatric surgical emergencies, to integrate pediatric and pediatric surgical care and to advocate for a comprehensive approach to emergency care of the critically ill child.
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Affiliation(s)
- Bich-Uyen Nguyen
- Department of Pediatric Surgery, Ho Chi Minh University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Aixuan Holterman
- Department of Surgery at Peoria and Chicago; Department of Pediatrics at Chicago, University of Illinois College of Medicine at Peoria and Chicago, Chicago, IL, United States
| | - Mark Holterman
- Department of Surgery at Peoria and Chicago; Department of Pediatrics at Chicago, University of Illinois College of Medicine at Peoria and Chicago, Chicago, IL, United States
| | - Le-Thanh Dinh
- Department of Pediatric Surgery, Children’s Hospital 1, Ho Chi Minh City, Vietnam
- Correspondence: L-T Dinh
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Do SN, Luong CQ, Pham DT, Nguyen MH, Ton TT, Hoang QTA, Nguyen DT, Pham TTN, Hoang HT, Khuong DQ, Nguyen QH, Nguyen TA, Tran TT, Vu LD, Van Nguyen C, McNally BF, Ong MEH, Nguyen AD. Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study. BMC Emerg Med 2021; 21:148. [PMID: 34814830 PMCID: PMC8609736 DOI: 10.1186/s12873-021-00542-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. METHODS We performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. RESULTS Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively). CONCLUSION In this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.
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Affiliation(s)
- Son Ngoc Do
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.,Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Chinh Quoc Luong
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam. .,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam. .,Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
| | - Dung Thi Pham
- Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - My Ha Nguyen
- Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tra Thanh Ton
- Emergency Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Quoc Trong Ai Hoang
- Emergency Department, Hue Central General Hospital, Hue City, Thua Thien Hue, Vietnam
| | - Dat Tuan Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Thao Thi Ngoc Pham
- Intensive Care Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam.,Department of Critical Care, Emergency Medicine and Clinical Toxicology, Faculty of Medicine, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hanh Trong Hoang
- Intensive Care Department, Hue Central General Hospital, Hue City, Thua Thien Hue, Vietnam.,Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Hue City, Thua Thien Hue, Vietnam
| | - Dai Quoc Khuong
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Quan Huu Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tung Thanh Tran
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Long Duc Vu
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Chi Van Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Bryan Francis McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Anh Dat Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
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Do SN, Luong CQ, Pham DT, Nguyen CV, Ton TT, Pham TT, Hoang QT, Hoang HT, Nguyen DT, Khuong DQ, Nguyen QH, Nguyen TA, Pham HT, Nguyen MH, McNally BF, Ong ME, Nguyen AD. Survival after out-of-hospital cardiac arrest, Viet Nam: multicentre prospective cohort study. Bull World Health Organ 2020; 99:50-61. [PMID: 33658734 DOI: 10.2471/blt.20.269837] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/14/2020] [Accepted: 10/06/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate factors associated with survival after out-of-hospital cardiac arrest in Viet Nam. Methods We did a multicentre prospective observational study of people (> 18 years) presenting with out-of-hospital cardiac arrest (not caused by trauma) to three tertiary hospitals in Viet Nam from February 2014 to December 2018. We collected data on characteristics, management and outcomes of patients with out-of-hospital cardiac arrest and compared these data by type of transportation to hospital and survival to hospital admission. We assessed factors associated with survival to admission to and discharge from hospital using logistic regression analysis. Findings Of 590 eligible people with out-of-hospital cardiac arrest, 440 (74.6%) were male and the mean age was 56.1 years (standard deviation: 17.2). Only 24.2% (143/590) of these people survived to hospital admission and 14.1% (83/590) survived to hospital discharge. Most cardiac arrests (67.8%; 400/590) occurred at home, 79.4% (444/559) were witnessed by bystanders and 22.3% (124/555) were given cardiopulmonary resuscitation by a bystander. Only 8.6% (51/590) of the people were taken to hospital by the emergency medical services and 32.2% (49/152) received pre-hospital defibrillation. Pre-hospital defibrillation (odds ratio, OR: 3.90; 95% confidence interval, CI: 1.54-9.90) and return of spontaneous circulation in the emergency department (OR: 2.89; 95% CI: 1.03-8.12) were associated with survival to hospital admission. Hypothermia therapy during post-resuscitation care was associated with survival to discharge (OR: 5.44; 95% CI: 2.33-12.74). Conclusion Improvements are needed in the emergency medical services in Viet Nam such as increasing bystander cardiopulmonary resuscitation and public access defibrillation, and improving ambulance and post-resuscitation care.
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Affiliation(s)
- Son N Do
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Chinh Q Luong
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Dung T Pham
- Department of Nutrition and Food Safety, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Chi V Nguyen
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Tra T Ton
- Emergency Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Thao Tn Pham
- Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Quoc Ta Hoang
- Emergency Department, Hue Central General Hospital, Hue, Viet Nam
| | - Hanh T Hoang
- Intensive Care Unit, Hue Central General Hospital, Hue, Viet Nam
| | - Dat T Nguyen
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Dai Q Khuong
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Quan H Nguyen
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Tuan A Nguyen
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Hanh Tm Pham
- Department of Epidemiology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - My H Nguyen
- Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Bryan F McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, United States of America
| | - Marcus Eh Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Anh D Nguyen
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
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