Hiromichi Naito1, Tetsuya Yumoto2, Takashi Yorifuji3, Yoshio Tahara4, Naohiro Yonemoto5, Hiroshi Nonogi6, Ken Nagao7, Takanori Ikeda8, Naoki Sato9, Hiroyuki Tsutsui10. 1. Okayama University Hospital, Advanced Emergency and Critical Care Medical Center, Japan. Electronic address: naito.hiromichi@gmail.com. 2. Okayama University Hospital, Advanced Emergency and Critical Care Medical Center, Japan. 3. Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan. 4. National Cerebral and Cardiovascular Center, Department of Cardiovascular Medicine, Japan. 5. National Center of Neurology and Psychiatry, Japan. 6. Shizuoka General Hospital, Intensive Care Center, Japan. 7. Nihon University Hospital, Cardiovascular Center, Japan. 8. Toho University Faculty of Medicine, Department of Cardiovascular Medicine, Japan. 9. Kawaguchi Cardiovascular and Respiratory Hospital, Cardiovascular Medicine, Japan. 10. Kyushu University Faculty of Medical Sciences, Department of Cardiovascular Medicine, Japan.
Abstract
BACKGROUND: Emergency life-saving technicians (ELSTs) are specially trained prehospital medical providers believed to provide better care than basic emergency medical technicians (BEMTs). ELSTs are certified to perform techniques such as administration of advanced airways or adrenaline and are considered to have more knowledge; nevertheless, ELSTs' effectiveness over BEMTs regarding out-of-hospital cardiac arrest (OHCA) remains unclear. We investigated whether the presence of an ELST improves OHCA patient outcomes. METHODS: In a retrospective study of adult OHCA patients treated in Japan from 2011 to 2015, we compared two OHCA patient groups: patients transported with at least one ELST and patients transported by only BEMTs. The primary outcome measure was one-month favorable neurological outcomes, defined as Cerebral Performance Category ≤ 2. A multivariable logistic regression model was used to calculate odds ratios (ORs) and their confidence intervals (CIs) to evaluate the effect of ELSTs. RESULTS: Included were 552,337 OHCA patients, with 538,222 patients in the ELST group and 14,115 in the BEMT group. The ELST group had a significantly higher odds of favorable neurological outcomes (2.5% vs. 2.1%, adjusted OR 1.39, 95% CI 1.17-1.66), one-month survival (4.9% vs. 4.1%, adjusted OR 1.37, 95% CI 1.22-1.54), and return of spontaneous circulation (8.1% vs. 5.1%, adjusted OR 1.90, 95% CI 1.72-2.11) compared with the BEMT group. However, ELSTs' limited procedure range (adrenaline administration or advanced airway management) did not promote favorable neurological outcomes. CONCLUSIONS: Compared with the BEMT group, transport by the ELST group was associated with better neurological outcomes in OHCA.
BACKGROUND: Emergency life-saving technicians (ELSTs) are specially trained prehospital medical providers believed to provide better care than basic emergency medical technicians (BEMTs). ELSTs are certified to perform techniques such as administration of advanced airways or adrenaline and are considered to have more knowledge; nevertheless, ELSTs' effectiveness over BEMTs regarding out-of-hospital cardiac arrest (OHCA) remains unclear. We investigated whether the presence of an ELST improves OHCA patient outcomes. METHODS: In a retrospective study of adult OHCA patients treated in Japan from 2011 to 2015, we compared two OHCA patient groups: patients transported with at least one ELST and patients transported by only BEMTs. The primary outcome measure was one-month favorable neurological outcomes, defined as Cerebral Performance Category ≤ 2. A multivariable logistic regression model was used to calculate odds ratios (ORs) and their confidence intervals (CIs) to evaluate the effect of ELSTs. RESULTS: Included were 552,337 OHCA patients, with 538,222 patients in the ELST group and 14,115 in the BEMT group. The ELST group had a significantly higher odds of favorable neurological outcomes (2.5% vs. 2.1%, adjusted OR 1.39, 95% CI 1.17-1.66), one-month survival (4.9% vs. 4.1%, adjusted OR 1.37, 95% CI 1.22-1.54), and return of spontaneous circulation (8.1% vs. 5.1%, adjusted OR 1.90, 95% CI 1.72-2.11) compared with the BEMT group. However, ELSTs' limited procedure range (adrenaline administration or advanced airway management) did not promote favorable neurological outcomes. CONCLUSIONS: Compared with the BEMT group, transport by the ELST group was associated with better neurological outcomes in OHCA.