Variation of current protocols for managing out-of-hospital cardiac arrest in prehospital settings among Asian countries

Chih Hao Lin, Yih Yng Ng, Wen Chu Chiang, Sarah Abdul Karim, Sang Do Shin, Hideharu Tanaka, Tatsuya Nishiuchi, Kentaro Kajino, Nalinas Khunkhlai, Matthew Huei Ming Ma, Marcus Eng Hock Ong

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background/Purpose Protocols for managing patients with out-of-hospital cardiac arrest (OHCA) may vary due to legal, cultural, or socioeconomic concerns. We sought to assess international variation in policies and protocols related to OHCA. Methods A brief survey was developed by consensus. Elicited information included protocols for managing patients with nontraumatic OHCA or traumatic OHCA, policies for using automated external defibrillators (AEDs) during transportation of patients with ongoing resuscitation, and application of terminations of resuscitation (TOR) rules in prehospital settings in the respondent's city or country. The populations of interest were emergency physicians, medical directors of emergency medical services (EMS), and policy makers. Results Responses were obtained from eight cities in six Asian countries. Only one (12.5%) city applied TOR rules for OHCAs. Do-not-resuscitate (DNR) orders were valid in prehospital settings in five (62.5%) cities. All cities used AEDs for nontraumatic OHCAs; seven (87.5%) cities did not routinely use AEDs for traumatic OHCAs. For nontraumatic OHCAs, four (50%) cities performed 2 minutes of on-scene cardiopulmonary resuscitation (CPR) and then transported the patients with ongoing resuscitation to hospitals; three (37.5%) cities performed 4 minutes of on-scene CPR; one (12.5%) city allowed variation in the duration of on-scene CPR. Conclusion International variation in practices and polices related to OHCAs do exist. Concerns regarding prehospital TOR rules include medical evidence, legal considerations, EMS manpower, public perception, medical oversight, education, EMS characteristics, and cost-effectiveness analysis. Further research is needed to achieve consensus regarding management protocols, especially for EMS that perform resuscitation during transportation of OHCA patients.

Original languageEnglish
Pages (from-to)628-638
Number of pages11
JournalJournal of the Formosan Medical Association
Volume115
Issue number8
DOIs
StatePublished - 1 Aug 2016

Keywords

  • Out-of-hospital Cardiac Arrest
  • Prehospital
  • Protocol

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