Thai Journal of Emergency Medicine

Outcomes of Out-of-Hospital Cardiac Arrest After Implementing a Public Access Defibrillation Program Supported by Local Communities in Sungai Kolok, Narathiwat

2023-10-14T10:46:40+07:00

Introduction
Out of hospital cardiac arrest (OHCA) often involves shockable rhythms treatable with automated external defibrillator (AED), is in the chain of survival. Su-ngaikolok residents have recognized and implemented AED according to the guidelines of the public access defibrillation program.

Objective
This study analyzes OHCA cases before and after AED installation, AED usage patterns, survival rates of OHCA patients in Su-ngaikolok district.

Methods
OHCA patient data was retrospectively collected, comparing cases before (n=67) and after (n=91) AED installation from October 2016 to February 2022. Statistical analysis employed chi-square tests and independent t-tests.

Results
The sample (n = 158) mainly comprised males, aged over 60 years, with incidents occurring at home. Initial cardiac rhythms were predominantly asystole or pulseless electrical activity (PEA). Comparing before and after AED installation, there were significant associations with advanced life support ambulance transportation, witness transports, responder AED training and onset to AED (p-value < .05). Survival rates showed improvement: return of spontaneous circulation (ROSC) from 37.3% to 46.2% (p-value .266), survival to admission from 28.4% to 29.7% (p-value .858) and survival to discharge from 1.5% to 7.7% (p-value .078) respectively. Following AED installation, the usage rate was 49.5%, with mobile AEDs accounting for 93.3% and fixed location AEDs 6.7%, corresponding to usage rates of 10.5 and 0.075 times per year, respectively. When comparing variables affecting survival to discharge, it was found that AED usage patterns, CPR duration and initial cardiac rhythms (asystole, PEA 14.29%, ventricular tachycardia, ventricular fibrillation 85.71%) have a statistically significant ( p-value < .05).

Conclusions:
AED usage. Using a mobile AED yields 140 times higher than fixed location Proper installation in suitable locations is crucial for successful OHCA response.

Association between Prehospital National Early Warning Score (NEWS) And the older Patients’Mortality Rate

2023-07-31T13:44:55+07:00

Introduction
National Early Warning Score (NEWS) is one of the recognized tools for the early identification of clinical deterioration using seven basic physiological findings. The use of the new score is primarily for adults within hospital settings. However, studies evaluating the NEWS in prehospital settings for older patients are limited.

Objectives
To determine the association of NEWS and 30-day mortality among older patients in the prehospital settings.

Method
A retrospective cohort study enrolled older patients age ≥65 years who visited the emergency department (ED) by emergency medical service (EMS) from 1 November 2021 to 1 February 2023. The data were collected from electronic medical record and medical record at the scene. The association between NEWS and 30-day mortality was assessed.

Results
Five hundred and seven patients were enrolled in this study. The 30-day mortality was 19.7%. Area under receiving operating characteristic curve (AUROC) was 0.726. NEWS ≥8 predicted mortality with sensitivity 73% (95%CI, 64-81) and specificity 63.6% (95%CI, 58.7-68.1).

Conclusion
Pre-hospital NEWS was associated with 30-day mortality in older patients. Therefore, pre-hospital NEWS may be useful to recognize early signs of clinical deteriorate in older patients and may be applied in emergency medical service in order to provide prompt an appropriate treatment to these patients.

Clinical Characteristics of Patients Under Investigation For COVID-19 In Emergency Department

2023-09-24T10:50:20+07:00

Introduction
The COVID-19 pandemic caused by SARS-CoV-2 infection poses a substantial public health challenge. Understanding the clinical features of patients presenting at the emergency department (ED) who meet the screening and investigation criteria for the novel coronavirus is crucial for accurate diagnosis and management. This study aimed to assess the clinical characteristics and identify risk factors among patients undergoing screening for SARS-CoV-2 infection.

Methods
In this retrospective analytical study, data were collected from 313 patients who visited the ED of Thammasat University Hospital between March 1, 2020, and July 31, 2021. The collected data were analyzed for the patients’ clinical characteristics, risk factors, and treatment outcomes using univariate and logistic regression analysis.

Results
Of the 313 patients, 100 had COVID-19. Among the cases, 22.36% had a history of exposure to individuals exhibiting fever or flu-like symptoms within a 14-day period. The main symptoms were dyspnea, fever, cough, and rhinorrhea (76.04%, 64.86%, 52.08%, and 13.74%, respectively). Additionally, 55.91% of patients had low oxygen saturation (≤80%), while 83.90% showed abnormalities in chest X-ray. Respiratory support was provided to 66% of the patients. The majority of patients (89.14%) were admitted to the hospital, and mortality rate was 20.13%. The study identified a higher body mass index (BMI) of ≥40 kg/m2, oxygen saturation≤80%, rhinorrhea, dyspnea and exposure to individuals with fever or flu-like symptoms within 14 days as risk factors for COVID-19.

Conclusion
Dyspnea, fever, cough, rhinorrhea and desaturation were important signs for patients undergoing investigations for COVID-19. A significant risk factor was close contact with individuals exhibiting fever or flu-like symptoms within 14 days.

Lung ultrasound score for predicting endotrcheal tube intubation in patients with community- acquired pneumonia: Pilot study

2023-12-19T18:14:51+07:00

Introduction
Community-acquired pneumonia is a common and high-mortality condition. A new trend of lung ultrasound has been recently utilized for diagnosis of pneumonia due to minimal radiation exposure and bedside convenience. Lung ultrasound score has been known for its capabilities for assessing severity, mortality, and length of hospital stay in several conditions. However, it has not been investigated in patients presenting with community-acquired pneumonia. Therefore, we aimed to evaluate the association between lung ultrasound scores and 72-hour endotracheal intubation.

Methods
A pilot observational study was conducted in an emergency department from March 2022 to April 2023. We enrolled all patients who were at least 18 years old with a diagnosis of community-acquired pneumonia and excluded patients with pregnancy, receiving mechanical ventilation at emergency department arrival, COVID-19 infection, and do-not-resuscitate orders. All eligible patients underwent a 12-region lung ultrasound and were rated a calculated ultrasound score of 0–3 in each region. The sum of lung ultrasound scores in each region was analyzed to determine the association between lung ultrasound scores and 72-hour endotracheal intubation.

Results
A total of 20 patients were analyzed. We observed that the increased lung ultrasound score was associated with 72-hour endotracheal intubation (p = 0.02). The receiver operator characteristic analysis indicated an area under the curve of 0.83 (95% CI, 0.6-1.0). In addition, the optimal cut-off value of the lung ultrasound score value for predicting 72-hour endotracheal intubation was 19, which demonstrated the highest sensitivity of 75% (95%CI, 34.9-96.8), a specificity of 83.3% (95%CI, 51.6-97.9), a positive predictive value of 75% (95%CI, 44.3-91.9), and a negative predictive value of 83.3% (95%CI, 59.5-94.5).

Conclusions
An increased lung ultrasound score was associated with 72-hour endotracheal intubation. Since it was conducted as a pilot study, further research is required to validate its outcome.