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Location of arrest and effect of prehospital advanced airway management after emergency medical service-witnessed out-of-hospital cardiac arrest: nationwide observational study
  1. Jeong Ho Park1,
  2. Kyoung Jun Song2,
  3. Sang Do Shin1,
  4. Young Sun Ro3,
  5. Ki Jeong Hong1,
  6. So Yeon Kong3
  1. 1 Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, The Republic of Korea
  2. 2 Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, The Republic of Korea
  3. 3 Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, The Republic of Korea
  1. Correspondence to Professor Kyoung Jun Song; skciva{at}


Objectives To investigate the association of prehospital advanced airway management (AAM) on outcomes of emergency medical service (EMS)-witnessed out-of-hospital cardiac arrest (OHCA) according to the location of arrest.

Methods We evaluated a Korean national OHCA database from 2012 to 2016. Adults with EMS-witnessed, non-traumatic OHCA were included. Patients were categorised into four groups according to whether prehospital AAM was conducted (yes/no) and location of arrest (‘at scene’ or ‘in the ambulance’). The primary outcome was discharge with good neurological recovery (cerebral performance category 1 or 2). Multivariable logistic regression analysis was conducted to evaluate the association between AAM and outcome according to the location of arrest.

Results Among 6620 cases, 1425 (21.5%) cases of arrest occurred ‘at the scene’, and 5195 (78.5%) cases of arrest occurred ‘in an ambulance’. Prehospital AAM was performed in 272 (19.1%) OHCAs occurring ‘at the scene’ and 645 (12.4%) OHCAs occurring ‘in an ambulance’. Patients with OHCA in the ambulance who had prehospital AAM showed the lowest good neurological recovery rate (6.0%) compared with OHCAs in the ambulance with no AAM (8.9%), OHCA at scene with AAM (10.7%) and OHCA at scene with no AAM (7.7%). For OHCAs occurring in the ambulance, the use of AAM had an adjusted OR of 0.67 (95% CI 0.45 to 0.98) for good neurological recovery.

Conclusion Our data show no benefit of AAM in patients with EMS-witnessed OHCA. For patients with OHCA occurring in the ambulance, AAM was associated with worse clinical outcome.

  • cardiac arrest
  • pre-hospital
  • airway

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  • Contributors SDOS, KJS, SYK and YSR conceived the study, designed the analysis. SDOS and KJS supervised the conduct of this study. SYK, YSR and KJH got the released data from Korean CDC and managed the data including quality control. YSR and JHP provided statistical advice on study design and analysed the data. JHP drafted the manuscript, and all authors contributed substantially to its revision. KJS took responsibility for the paper as a whole.

  • Funding This study was supported by the National Emergency Management Agency of Korea and the Korea Centers for Disease Control and Prevention (CDC) (2012-E33010-00, 2013-E33015- 00, 2014-E33011-00).

  • Competing interests None declared.

  • Ethics approval Ethical approval for research using OHCA data was obtained from Seoul National University Hospital Institutional Review Board (H-1103-153-357).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.