• Humans
• Out-of-Hospital Cardiac Arrest/therapy
• Out-of-Hospital Cardiac Arrest/mortality
• Out-of-Hospital Cardiac Arrest/epidemiology
• Female
• Retrospective Studies
• Male
• Emergency Medical Services/statistics & numerical data
• Paris/epidemiology
• Aged
• Middle Aged
• Social Class
• Time-to-Treatment/statistics & numerical data
• Health Services Accessibility/statistics & numerical data
• Registries
• Healthcare Disparities/statistics & numerical data
• Time Factors
• Cardiopulmonary Resuscitation/statistics & numerical data
• Cohort Studies
• Low Socioeconomic Status

• COVID-19
• fever
• heart arrest
• mortality

• Humans
• COVID-19/mortality
• COVID-19/complications
• Male
• Female
• Retrospective Studies
• Fever/mortality
• Republic of Korea/epidemiology
• Middle Aged
• Hospital Mortality
• Aged
• Out-of-Hospital Cardiac Arrest/mortality
• Out-of-Hospital Cardiac Arrest/epidemiology
• Emergency Service, Hospital/statistics & numerical data
• SARS-CoV-2
• Adult
• Aged, 80 and over
• Disease Outbreaks

• emergency medical services
• emergency medicine
• epidemiology
• rural health

• Out-of-Hospital Cardiac Arrest/epidemiology
• Out-of-Hospital Cardiac Arrest/therapy
• Humans
• Retrospective Studies
• Female
• Western Australia/epidemiology
• Male
• Middle Aged
• Aged
• Emergency Medical Services/statistics & numerical data
• Aged, 80 and over
• Rural Population/statistics & numerical data
• Adult
• Cardiopulmonary Resuscitation/statistics & numerical data
• Incidence
• Cohort Studies

• Aortic occlusion
• Cardiopulmonary resuscitation
• Emergency medical services
• Endovascular
• Intra-aortic balloon
• Swine

• Advanced Life Support
• Emergency medical services
• Out-of-hospital cardiac arrest

• Adult
• Humans
• Cardiopulmonary Resuscitation
• Cohort Studies
• Air Ambulances
• Out-of-Hospital Cardiac Arrest/therapy
• Reaction Time
• Unmanned Aerial Devices
• Emergency Medical Services

• building floor
• emergency medical services
• out-of-hospital cardiac arrest
• survival
• vertical location

• automated external defibrillator
• basic life support
• first responder
• out-of-hospital cardiac arrest
• police

• Emergency medical services
• Incidence
• Out of Hospital Cardiac arrest
• Rural Health
• Survival

• AED
• Access to urgent care
• Automated external defibrillator
• Out-of-hospital cardiac arrest
• Socioeconomic inequities

Out-of-hospital cardiac arrest (OHCA) remains one of the leading causes of death worldwide, and bystander CPR with public-access defibrillation improves OHCA survival outcomes. The COVID-19 pandemic has posed many challenges for emergency medical services (EMS), including the suggestion of compression-only resuscitation and recommendations for complete personal protective equipment, which have created operational difficulties and prolonged response time. However, the risk factors affecting OHCA outcomes during the pandemic are poorly defined. This study aimed to assess the characteristics and outcomes of OHCA patients before and during the COVID-19 pandemic in Thailand.

This single-center, retrospective cohort study used data from electronic medical records and EMS paper records. All OHCA patients who visited Ramathibodi Hospital’s emergency department before COVID-19 (March 2018 to December 2019) and during COVID-19 (March 2020-December 2021) were identified, and the number of emergency department returns of spontaneous circulation (ED-ROSC) and characteristics in OHCA patients before and during the COVID-19 pandemic in Thailand were collected.

A total of 136 patients were included (78 men [59.1%]; mean [SD] age, 67.9 [18] years); 60 of these were during the COVID-19 period (beginning March 2020), and 76 were before the COVID-19 period. The overall baseline characteristics that differed significantly between the two groups were bystander witness and mode of chest compression (p-values < 0.001 and < 0.001, respectively). The ED ROSC during the COVID-19 period was significantly lower than before the COVID-19 period (26.67% vs. 46.05%, adjusted OR 0.21, p-value < 0.001). There were significant differences in survival to admission between the COVID-19 period and before (25.00% and 40.79%, adjusted OR 0.26, p-value 0.005). However, 30-day survivals were not significantly different (3.3% during the COVID-19 period and 10.53% before the COVID-19 period).

During the COVID-19 pandemic in Thailand, ED ROSC and survival to admission in out-of-hospital cardiac arrest patients were significantly reduced. Additionally, the witness responses and mode of chest compression were very different between the two groups.

This trial was retrospectively registered on 7 December 2021 in the Thai Clinical Trial Registry, identification number TCTR20211207006.

The online version contains supplementary material available at 10.1186/s12245-022-00444-2.

• 30-day survival
• COVID-19
• Emergency department
• Out-of-hospital cardiac arrest
• Pandemic
• Return of spontaneous circulation
• SARS-CoV-2
• Survival to admission

• Ambulance Reallocation
• Ambulance response time
• Computer simulation
• Emergency Medical Services

• cost-benefit analysis
• economic value
• endogeneity
• patient outcomes
• response time

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Child, Preschool
• Cost-Benefit Analysis
• Emergency Medical Services/economics
• Emergency Medical Services/statistics & numerical data
• Female
• France
• Humans
• Infant
• Infant, Newborn
• Logistic Models
• Male
• Middle Aged
• Outcome Assessment, Health Care
• Patient Acuity
• Time Factors
• Young Adult

During the coronavirus disease 2019 (COVID-19) pandemic, prehospital times were delayed for patients who needed to arrive at the hospital in a timely manner to receive treatment. To address this, in March 2020, the Korean government designated emergency medical centers for critical care (EMC-CC). This study retrospectively analyzed whether this intervention effectively reduced ambulance diversion (AD) and shortened prehospital times using emergency medical service records from 219,763 patients from the Gyeonggi Province, collected between 1 January and 31 December 2020. We included non-traumatic patients aged 18 years or older. We used interrupted time series analysis to investigate the intervention effects on the daily AD rate and compared prehospital times before and after the intervention. Following the intervention, the proportion of patients transported 30–35 km and 50 km or more was 13.8% and 5.7%, respectively, indicating an increased distance compared to before the intervention. Although the change in the AD rate was insignificant, the daily AD rate significantly decreased after the intervention. Prehospital times significantly increased after the intervention in all patients (p < 0.001) and by disease group; all prehospital times except for the scene time of cardiac arrest patients increased. In order to achieve optimal treatment times for critically ill patients in a situation that pushes the limits of the medical system, such as the COVID-19 pandemic, even regional distribution of EMC-CC may be necessary, and priority should be given to the allocation of care for patients with mild symptoms.

• COVID-19
• ambulance diversion
• emergency medical services
• prehospital
• time factors

• Emergency Medical Services
• cardiac arrest
• emergency health services
• health policy
• motorcycles
• response time

• Ambulances
• Cities
• Cross-Sectional Studies
• Emergency Medical Services
• Health Promotion
• Humans
• Male
• Motorcycles
• Sustainable Development

Point-of-care ultrasounds (US) are used during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC). Carotid ultrasounds are a potential non-invasive monitoring tool for chest compressions, but their general value and feasibility during CPR are not fully determined. In this prospective observational study, we performed carotid US during conventional- and extracorporeal CPR and after ROSC with at least one transverse and coronal image, corresponding loops with and without color doppler, and pulsed-wave doppler loops. The feasibility of carotid US during (peri-)arrest and type and frequency of diagnostic findings were examined. We recruited 16 patients and recorded utilizable US images in 14 cases (88%; complete imaging protocols in 11 patients [69%]). In three of all patients (19%) and in 60% (3/5) of cases during CPR plus a full imaging protocol, we observed: (i) in one patient a collapse of the common carotid artery linked to hypovolemia, and (ii) in two patients a biphasic flow during CPR linked to prolonged low-flow time prior to admission and adverse outcome. Carotid artery morphology and carotid blood flow characteristics may serve as therapeutic target and prognostic parameters. However, future studies with larger sample sizes are needed.

• Cardiopulmonary resuscitation
• Emergency medical services
• Scene time interval

• cardiac arrest
• chain of survival
• effectiveness

What characteristics are associated with out-of-hospital cardiac arrests and death during the COVID-19 pandemic in New York City?

In this population-based cross-sectional study of 5325 patients with out-of-hospital cardiac arrests, the number undergoing resuscitation was 3-fold higher during the 2020 COVID-19 period compared with during the comparison period in 2019. Patients with out-of-hospital cardiac arrest during 2020 were older, less likely to be white, and more likely to have specific comorbidities and substantial reductions in return and sustained return of spontaneous circulation.

Identifying patients at risk for out-of-hospital cardiac arrest and death during the COVID-19 pandemic should lead to interventions in the outpatient setting to help reduce out-of-hospital deaths.

Risk factors for out-of-hospital death due to novel coronavirus disease 2019 (COVID-19) are poorly defined. From March 1 to April 25, 2020, New York City, New York (NYC), reported 17 118 COVID-19–related deaths. On April 6, 2020, out-of-hospital cardiac arrests peaked at 305 cases, nearly a 10-fold increase from the prior year.

To describe the characteristics (race/ethnicity, comorbidities, and emergency medical services [EMS] response) associated with outpatient cardiac arrests and death during the COVID-19 pandemic in NYC.

This population-based, cross-sectional study compared patients with out-of-hospital cardiac arrest receiving resuscitation by the NYC 911 EMS system from March 1 to April 25, 2020, compared with March 1 to April 25, 2019. The NYC 911 EMS system serves more than 8.4 million people.

The COVID-19 pandemic.

Characteristics associated with out-of-hospital arrests and the outcomes of out-of-hospital cardiac arrests.

A total of 5325 patients were included in the main analysis (2935 men [56.2%]; mean [SD] age, 71 [18] years), 3989 in the COVID-19 period and 1336 in the comparison period. The incidence of nontraumatic out-of-hospital cardiac arrests in those who underwent EMS resuscitation in 2020 was 3 times the incidence in 2019 (47.5/100 000 vs 15.9/100 000). Patients with out-of-hospital cardiac arrest during 2020 were older (mean [SD] age, 72 [18] vs 68 [19] years), less likely to be white (611 of 2992 [20.4%] vs 382 of 1161 [32.9%]), and more likely to have hypertension (2134 of 3989 [53.5%] vs 611 of 1336 [45.7%]), diabetes (1424 of 3989 [35.7%] vs 348 of 1336 [26.0%]), and physical limitations (2259 of 3989 [56.6%] vs 634 of 1336 [47.5%]). Compared with 2019, the odds of asystole increased in the COVID-19 period (odds ratio [OR], 3.50; 95% CI, 2.53-4.84; P < .001), as did the odds of pulseless electrical activity (OR, 1.99; 95% CI, 1.31-3.02; P = .001). Compared with 2019, the COVID-19 period had substantial reductions in return of spontaneous circulation (ROSC) (727 of 3989 patients [18.2%] vs 463 of 1336 patients [34.7%], P < .001) and sustained ROSC (423 of 3989 patients [10.6%] vs 337 of 1336 patients [25.2%], P < .001), with fatality rates exceeding 90%. These associations remained statistically significant after adjustment for potential confounders (OR for ROSC, 0.59 [95% CI, 0.50-0.70; P < .001]; OR for sustained ROSC, 0.53 [95% CI, 0.43-0.64; P < .001]).

In this population-based, cross-sectional study, out-of-hospital cardiac arrests and deaths during the COVID-19 pandemic significantly increased compared with the same period the previous year and were associated with older age, nonwhite race/ethnicity, hypertension, diabetes, physical limitations, and nonshockable presenting rhythms. Identifying patients with the greatest risk for out-of-hospital cardiac arrest and death during the COVID-19 pandemic should allow for early, targeted interventions in the outpatient setting that could lead to reductions in out-of-hospital deaths.

• dust explosion
• emergency medical regulation center (emrc)
• emergency medical service (ems)
• ems transportation
• mass casualty incident (mci)

• Adolescent
• Adult
• Dust
• Emergency Medical Services/methods
• Emergency Medical Services/statistics & numerical data
• Explosions
• Female
• Hospitals/statistics & numerical data
• Humans
• Male
• Mass Casualty Incidents
• Taiwan
• Time Factors
• Transportation of Patients/statistics & numerical data
• Triage/methods
• Triage/statistics & numerical data
• Young Adult

• Dispatched
• Emergency medical control center
• Emergency medical dispatch
• Job cycle time
• OFF-Mission
• ON-Mission
• Prehospital emergency care
• Rural
• Triaged
• Urban

• Ambulatory Care
• Emergency Medical Dispatch
• Emergency Medical Services
• Emergency Medicine
• Germany
• Humans
• Retrospective Studies

• Johann Wolfgang Goethe-Universität, Frankfurt am Main (1022)

In addition to the directly attributed mortality, COVID-19 is also likely to increase mortality indirectly. In this systematic review, we investigate the direct and indirect effects of COVID-19 on out-of-hospital cardiac arrests.

We searched PubMed, BioMedCentral, Embase and the Cochrane Central Register of Controlled Trials for studies comparing out-of-hospital cardiac arrests occurring during the pandemic and a non-pandemic period. Risk of bias was assessed with the ROBINS-I tool. The primary endpoint was return of spontaneous circulation. Secondary endpoints were bystander-initiated cardiopulmonary resuscitation, survival to hospital discharge, and survival with favourable neurological outcome.

We identified six studies. In two studies, rates of return of spontaneous circulation and survival to hospital discharge decreased significantly during the pandemic. Especially in Europe, bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation and resuscitation attempted by emergency medical services were reduced during the pandemic. Also, ambulance response times were significantly delayed across all studies and patients presenting with non-shockable rhythms increased in two studies. In 2020, 3.9–5.9% of tested patients were SARS-CoV-2 positive and 4.8–26% had suggestive symptoms (fever and cough or dyspnoea).

Out-of-hospital cardiac arrests had worse short-term outcomes during the pandemic than a non-pandemic period suggesting direct effects of COVID-19 infection and indirect effects from lockdown and disruption of healthcare systems. Patients at high risk of deterioration should be identified outside the hospital to promptly initiate treatment and reduce fatalities.

Study registration PROSPERO CRD42020195794.

• COVID-19
• Cardiopulmonary resuscitation
• Out-of-hospital cardiac arrest

Access time to patients with critical or emergent situations outside the hospital is a critical factor that affects both severity of injury and survival. This study aimed to compare the access time to the scene of an emergency situation between a traditional ambulance and motorlance.

This prospective cross sectional study was conducted on all users of emergency call, Srinagarind Hospital, Thailand, from June to December 2018, who received a registration number from the command center.

504 emergency-service operations were examined over a six-month period, 252 (50%) of which were carried out by motorlance. The mean activation time for motorlance and ambulance were 0.57 ± 0.22 minutes and 1.11 ± 0.18 minutes, respectively (p<0.001). Mean response time for motorlance was significantly lower (5.57 ± 1.21 versus 7.29 ± 1.32 minutes; p < 0.001). The response times during 6 a.m. to 6 p.m. were 5.26 ± 1.11 minutes for motorlance and 7.15 ± 1.39 minutes for ambulance (p < 0.001). These measures for night time (6 p.m. to 6 a.m.) were 5.58 ± 1.21 minutes and 8.01 ± 1.30 minutes, respectively (p < 0.001). The mean automated external defibrillator (AED) waiting time for motorlance and ambulance were 5.26 ± 2.36 minutes and 9.24 ± 3.30 minutes, respectively (p = 0.012). The survival rate of patients after AED use in motorlance and ambulance was 80% versus 37.5%; p<0.001.

Emergency service delivery by motorlance had lower mean activation time, response time, AED time, and mortality rate of cardiac arrest patients compared to ambulance. It seems that motorlance could be considered as an effective and applicable device in emergency medical service delivery, especially in crowded cities with heavy traffic.

• Emergency medicine
• ambulances
• emergency medical services
• emergency mobile units

• Affordable care act
• Ambulance
• Health care capacity
• Health care workforce
• Health insurance

• Ambulances/statistics & numerical data
• Humans
• Insurance Coverage/legislation & jurisprudence
• Insurance Coverage/statistics & numerical data
• Medicaid/statistics & numerical data
• Medically Uninsured/statistics & numerical data
• Patient Protection and Affordable Care Act
• Surge Capacity
• Time Factors
• United States

• Prehospital treatment
• TAM model
• Vital signs monitoring
• Wireless sensors
• e-Triage

• Emergency Medical Services/methods
• Emergency Service, Hospital
• Equipment Design
• Glasgow Coma Scale
• Humans
• Monitoring, Physiologic/instrumentation
• Triage/methods
• User-Computer Interface
• Wireless Technology

• Cardiopulmonary resuscitation
• Return of spontaneous circulation
• Survival to discharge

• cardiac arrest
• cardiopulmonary resuscitation
• emergency medical services

To examine whether wearable cardioverter defibrillator (WCD) alarms for asystole improve patient outcomes and survival.

All asystole episodes recorded by the WCD in 2013 were retrospectively analyzed from a database of device and medical record documentation and customer call reports. Events were classified as asystole episodes if initial presenting arrhythmia was asystole (< 10 beats/minor ≥ 5 s pause). Survival was defined as recovery at the scene or arrival to a medical facility alive, or not requiring immediate medical attention. Episodes occurring in hospitals, nursing homes, or ambulances were considered to be under medical care. Serious asystole episodes were defined as resulting in unconsciousness, hospital transfer, or death.

Of the total 51933 patients having worn the WCD in 2013, there were 257 patients (0.5%) who had asystole episodes and comprised the study cohort. Among the 257 patients (74% male, median age 69 years), there were 264 asystole episodes. Overall patient survival was 42%. Most asystoles were considered “serious” (n = 201 in 201 patients, 76%), with a 26% survival rate. All 56 patients with “non-serious” asystole episodes survived. Being under medical care was associated with worse survival of serious asystoles. Among acute survivors, 20% later died during WCD use (a median 4 days post asystole episode). Of the 86 living patients at the end of WCD use period, 48 (56%) received ICD/pacemaker and 17 (20%) improved their condition.

Survival rates after asystole in patients with WCD are higher than historically reported survival rates. Those under medical care at time of asystole exhibited lower survival.

• Asystole
• Bradycardia
• Cardiac arrest
• Defibrillator
• LifeVest

• Advanced life support
• Response time
• Scene time
• Transport time

For out-of-hospital cardiac arrest (OHCA) patients, every second is vital for their life. Shortening the prehospital time is a challenge to emergency medical service (EMS) experts. This study focuses on the on-scene time evaluation of the registered nurses (RNs) participating in already existing EMS teams, in order to explore their role and performance in different EMS cases. In total, 1247 cases were separated into trauma and nontrauma cases. The nontrauma cases were subcategorized into OHCA (NT-O), critical (NT-C), and noncritical (NT-NC) cases, whereas the trauma cases were subcategorized into collar-and-spinal board fixation (T-CS), fracture fixation (T-F), and general trauma (T-G) cases. The average on-scene time of RN-attended cases showed a decrease of 21.05% in NT-O, 3.28% in NT-C, 0% in NT-NC, 18.44% in T-CS, 13.56% in T-F, and 3.46% in T-G compared to non-RN-attended. In NT-O and T-CS cases, the RNs' attendance can notably save the on-scene time with a statistical significance (P = .016 and .017, resp.). Furthermore, the return of spontaneous circulation within two hours (ROSC_2 h) rate in the NT-O cases was increased by 12.86%. Based on the findings, the role of RNs in the EMTs could save the golden time in the prehospital medical care in Taiwan.

• 3.5 G
• Google Maps
• WiMax
• speech recognition
• traffic guiding subsystem
• ubiquitous emergency medical service

• Ambulances
• Biosensing Techniques
• Computer Communication Networks
• Emergency Medical Services
• Wireless Technology

• Cardiac arrest
• Cardiopulmonary resuscitation
• Epidemiology
• Resuscitation time course

• Advanced life support
• Blood gas analysis
• CPR

• Acidosis/blood
• Aged
• Aged, 80 and over
• Blood Gas Analysis/statistics & numerical data
• Cardiopulmonary Resuscitation
• Female
• Humans
• Male
• Middle Aged
• Out-of-Hospital Cardiac Arrest/blood
• Out-of-Hospital Cardiac Arrest/mortality
• Out-of-Hospital Cardiac Arrest/therapy
• Prospective Studies
• Time Factors

Termination of resuscitation rule permits to stop futile resuscitative efforts by paramedics. In a different setting, the decision to withhold resuscitation by emergency physician could be based on different factors. We aimed to identify the factors associated with the initiation of a medical ACLS in out-of-hospital cardiac arrest patients.

We prospectively collected the characteristics of all out-of hospital cardiac arrest patients occurring in a French district between March 2010 and December 2013 and managed by the emergency medical system. We analyzed the factors associated with the initiation of medical ACLS.

Medical ACLS was initiated in 69 % of the 2690 patients included in the register. ACLS patients were younger (69 years [55–80] vs. 84 years [77–90]) and more frequently men. A higher percentage of witnessed cardiac arrest and BLS were observed. Duration of no-flow was shorter in the ACLS patients, whereas BLS duration was longer. A higher proportion of shockable rhythm and application of AED were found in this group. Mains factors associated with the initiation of medical ACLS were a suspected cardiac cause (1.73 [1.30–2.30]) and use of an automated external defibrillator (1.59 [1.18–2.16]), whereas factors associated with no medical ACLS were higher age (0.93 [0.92–0.94]), absence of BLS (0.62 [0.52–0.73]), asystole (0.31 [0.18–0.51]) and location in nursing home (0.23 [0.11–0.51]).

The medical decision to not initiate ACLS in out-of-hospital cardiac arrest patients seems to rely on a complex combination of validated criteria used for termination of resuscitation and factors resulting from an intuitive perception of the outcome.

• Medical resuscitation
• Out-of-hospital cardiac arrest
• Termination of resuscitation rule