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J Korean Soc Emerg Med > Volume 27(2); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(2): 165-172.
병원 밖에서 발생한 심인성 심장정지환자의 신경학적 결과 관련 요인 - 7년간 국가 심장정지조사사업 자료 활용 -
정수연1, 김철웅2, 윤태호3, 김유진4, 홍성옥4, 최정아4
1질병관리본부 에이즈∙결핵관리과
2충남대학교 의과대학 예방의학교실 의학연구소
3부산대학교 의과대학 예방의학교실
4질병관리본부 만성질환관리과
The Factors Influencing Neurological Outcome of Out-of-hospital Cardiac Arrest with Cardiac Etiology
Su Yeon Jeong1, Chul Woung Kim2, Tae Ho Yoon3, Yoo Jin Kim4, Sung Ok Hong4, Jung Ah Choi4
1Dvision of HIV/AIDS and TB Control, Korea Centers for Disease Control & Prevention, Chungbuk, Korea
2Department of Preventive Medicine, College of Medicine, Chungnam National University, Research Institute for Medical Sciences, Daejeon, Korea
3Department of Preventive Medicine, Busan National University School of Medicine, Busan, Korea
4Dvision of Chronic Disease Management, Korea Centers for Disease Control & Prevention, Chungbuk, Korea
Correspondence  Chul Woung Kim ,Tel: 042) 580-8268, Fax: 042) 583-7561, Email: woung@cnu.ac.kr,
Received: November 4, 2015; Revised: November 4, 2015   Accepted: December 10, 2015.  Published online: April 30, 2016.
The purpose of this study is to examine the factors associated with neurological outcome and to provide ideas for improving the operation of the emergency medical system in Korea.
A total of 95,911 out-of-hospital cardiac arrests (OHCAs) with cardiac etiology who were transported by 119 EMS ambulances for seven years from 2006 to 2012 in Korea were analyzed. According to these data there is a multilevel structure, so that patient’s neurological outcome in the same region is not independent but interrelated, therefore two-level (patient-region) logistic regression analysis was applied to adjust this correlation.
The adjusted odds ratio (OR) in the group in which Cardiopulmonary Resuscitation (CPR) was performed by a bystander was 1.27 for good neurological outcome. The adjusted OR in the group with implementation of an automated external defibrillator (AED) before arrival at the hospital was 4.11 for good neurological outcome. The adjusted OR in the numbers of emergency physicians compared with <3 was 2.76 (3-4), 4.24 (≥5) and the adjusted OR in OHCAs volume of each hospital compared with <50 was 2.31 (50-64), 2.51 (65-102), and 2.94 (≥103). The adjusted OR in deprivation level compared with <2 was 0.72 (≥2).
The neurological outcome was significantly better in the group in which CPR was performed by a bystander and AED was applied early. The neurological outcome tended to be significantly better in hospitals with higher numbers of emergency physicians and higher volume of OHCAs, in less deprived districts.
Key words: Multilevel analysis, Out-of-hospital Cardiac Arrest, Neurological outcome, Korea
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