Factors That Affect Recovery of Spontaneous Circulation by Patients With Cardiac Arrest Before Arrival at a Hospital in Daegu Metropolitan City, South Korea

Factors That Affect Recovery of Spontaneous Circulation by Patients With Cardiac Arrest Before Arrival at a Hospital in Daegu Metropolitan City, South Korea | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors That Affect Recovery of Spontaneous Circulation by Patients With Cardiac Arrest Before Arrival at a Hospital in Daegu Metropolitan City, South Korea Hyun-Ok Jung, Seungwoo Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-393200/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study was conducted to investigate the factors that influence Return of Spontaneous Circulation (ROSC) in patients who suffered cardiac arrest before arriving at the emergency room in DMC, Korea. Methods This study considered data for cardiac arrest patients by 119 paramedics from January 1, 2019 to December 31, 2019 in Daegu. Chi-squared analysis was conducted to analyze whether the subjects showed ROSC before arriving at the emergency room. Binary logic regression analysis was conducted to identify the factors that affect ROSC. Results ROSC when a mechanical compression device was used was reduced to 0.82 of that when it was not used (95% CI = 0.60 ~ 0.92). ROSC was 3.13 times higher when a first-aid defibrillator was used than when it was not used (95% CI = 1.40 ~ 6.99). ROSC was 657 times higher when epinephrine was injected than when it was not injected. Lastly, ROSC was 1.82 (95% CI = 1.04 ~ 3.19) times higher when intubation was used than when it was not used. Conclusion This study suggests that continuous CPR education, securing financial support, and expansion of emergency rooms for local residents are necessary. Critical Care & Emergency Medicine Sudden cardiac arrest Return of spontaneous circulation Cardiopulmonary resuscitation South Korea Background The death rate by Cardiovascular system disease in South Korea was 117.4 per 100,000 people in 2019.[1]. Sudden cardiac arrest (SCA) results in death with hemodynamic failure if the heart is not restarted within minutes [2]. In the United States, more than 550,000 patients suffer SCA each year before and during hospitalization, and SCA accounts for more than half of cardiovascular mortality, and is therefore a major concern for national interest and prevention [3]. The recovery rate of patients with cardiac arrest before arrival at the hospital in Korea increased by about 7 times from 1.1% in 2007 to 7.6% in 2017, but compared to advanced countries such as the US 11.4%, Sweden 14.0%, and Norway 13.0%, the rate is still very low [4, 5]. To solve the practical problems of emergency medical treatment, the Korean government has been actively studying the prevention and management of diseases by establishing cardiovascular and cerebrovascular prevention centers to consider the characteristics of each disease in Korea. Daegu Metropolitan City (DMC) in southeastern Korea has the fourth-largest population (2.4 million) in the country. The number of emergency room deaths among emergency-room users in DMC was 0.418%, which was the highest in the country, but the death rate before arrival in the emergency room was 0.05%, which was the lowest in the country [7]. Considering the these opposing characteristics in the emergency medical situations in DMC, the factors that influence Return of Spontaneous Circulation (ROSC) in patients with cardiac arrest in pre-hospital, where and rapid response is required, may contribute to improvement of community participation and emergency care. Previous studies have shown that pre-emergency factors that are closely related to patient survival rate include whether the cardiac arrest patient was witnessed, whether witnesses performed CPR, whether electrocardiogram rhythm was defibrillable, and whether the ROSC occurred spontaneously [8,9]. However, the factors that affect ROSC have not been studied in depth by country or region. This lack occurs because the environment and resources of emergency medical care in each country are different, so the rapid treatment and methods of coping with patients who have pre-hospital cardiac arrest may also differ. Rather than identifying the theoretically known factors that affect the ROSC, this study focuses on patient data applied by actual paramedic, and identifies factors that influence ROSC in the region in a practical and multifaceted manner, and thereby contributes to development of emergency medical services. Therefore, the goal of this study was to identify factors that can improve ROSC rate of pre-hospital cardiac arrest patients, and thereby provide basic data that can be exchanged between countries and contribute to development of emergency medical systems beyond the local community The purpose of this study is to determine whether patients with cardiac arrest recovered their circulation spontaneously before arriving at an emergency room in DMC in 2019, and to determine the factors that affected this recovery. The specific purposes were: To identify whether or not spontaneous circulation is restored before a patient arrives at the emergency room, and to identify factors that affect ROSC before a patient’s arrival in the emergency room. Methods Study Setting This study considered data from patients with cardiac arrest treated by 119 paramedics from January 1, 2019 to December 31, 2019 in DMC. For data collection, the purpose and suitability of the study was explained to the head of the DMC Fire Department, and the use of the data was approved. The emergency activity log and the details of the cardiopulmonary arrest detailed situation table were anonymized. The total number of cardiac arrest procedures during the target period was 2750. Among them, 1307 cases were selected for the ROSC; cases for which CPR was withheld or suspended by medical guidance of paramedics due to apparent death or other causes, were not considered. Data Collection This study selected and investigated items that are estimated to have an effect on ROSC, as suggested by the emergency-activity log and the detailed cardiopulmonary arrest schedule prepared by 119 paramedics. The dependent variables were the ROSC of cardiac arrest patients; independent variables were the Type of occurrence, Place of occurrence, Whether the cardiac arrest was witnessed, Whether CPR was performed, Whether a mechanical compression device was used, Whether a first-aid defibrillator was used, Whether epinephrine had been administered intravenously, and Whether intubation was performed. Specifically, ROSC was defined as (yes = 1, no = 2). The codes for independent variables were: Type of occurrence (disease = 1, non-disease = 2), Place of occurrence (house = 1, ambulance = 2, nursing institution (medical facility) = 3, other = 4), Whether the cardiac arrest was witnessed (Witnessed = 1, not witnessed = 2, unknown = 3), Whether CPR was performed (performed = 1, not performed = 2, unknown = 3), Whether a mechanical compression device was used (Used = 1, not used = 2), Whether a first-aid defibrillator was used (Used = 1, Not used = 2), Whether epinephrine had been administered intravenously (Secured = 1, Not secured = 2), and Whether intubation was performed (Performed = 1, Not performed = 2). Statistical Analysis In this study, IBM SPSS/WIN 23.0 Program was used for data analysis. Frequency analysis was used to quantify the general characteristics of the subjects, and Chi-squared analysis was conducted to analyze whether the subjects showed ROSC before arriving at the emergency room. Binary Logistic Regression Analysis was conducted to identify factors that affected ROSC. Ethical consideration The data in this study were approved and obtained from the emergency activity log and cardiopulmonary arrest detailed situation chart prepared by 119 paramedics at the DMC Fire Department, and obtained approval from K University Institutional Review Board (IRB) for the exemption of deliberation (IRB- 1041459-202103-HR-003-01). Results General characteristics of out-of-hospital cardiac arrest patients Of the patients, 90.3% had a disease. Home (86.9%) has the most frequent place of occurrence. Most of the cardiac arrests were not witnessed (69.9%), and CPR was usually not performed (63.2%). Mechanical compression devices were generally not used (60.4%), and first-aid defibrillators were generally not used (91.9%). Epinephrine was generally not administered intravenously (68.3%), and intubation was generally not performed (58.0%) (Table 1). Whether ROSC occurred before arriving at the emergency room according to characteristics related to the occurrence SROC before arriving at the emergency room was statistically more probable if the cardiac arrest was witnessed (χ2 = 29.727, P < 0.001), if CPR was performed (χ2 = 6.232, P = 0.044), if a mechanical compression device was used (χ2 = 95.596, P < 0.001), if a first-aid defibrillator was used (χ2 = 146.241, P < 0.001), and if intravenous access was secured (χ2 = 25.364, P <0.001) (Table 2). Factors that influenced ROSC before arrival at the emergency room This study confirmed that the factors that affect ROSC before arrival at the emergency room were: use of a mechanical compression device, use of a first-aid defibrillator, administration of epinephrine, and use of intubation. Compared to cases in which the method was not used, ROSC was reduced to 0.82 times when a mechanical compression device was used compared to when it was not used (95% CI = 0.60 ~ 0.92); 3.13 times higher when an electrical defibrillator was used (95% CI = 1.40 ~ 6.99); 6.57 times higher when intravenous access was used (95% CI = 2.16 ~ 19.53), and 1.82 times when intubation was used (95% CI = 1.04~3.19) (Table 3). Discussion This study confirmed that the use of a mechanical compression device affects the probability of ROSC before the patient arrives at the emergency room. These findings show that use of a mechanical compression device was less effective than manual CPR in achieving ROSC. This result contradicts a prior study [11], which showed that mechanical compression devices were more effective than CPR in achieving ROSC, and with a review of 1,187 systems [12], which showed no significant difference between mechanical compression devices and hand CPR in achieving ROSC. This conflicting finding may be a result of the situational environment of the country, because paramedics in Korea they tend to prefer hand CPR over mechanical compression unless the ambulance ride is long. In addition, mechanical compression devices are not always available in ambulances nationwide in Korea. These observations indicate that active research and preparation for the use of mechanical compression devices is necessary in Korea. To increase the efficiency of the use of mechanical compression devices, appropriate training on teamwork and the use of these machines should be provided, but the difference in education level and scope of work for each paramedic raises another practical problem. This study determined that use of a first aid defibrillator increased the ROSC by 3.13 times. A previous study [13] suggested that improvement of the quality of CPR and the availability of AEDs can improve the probability that a patient will survive heart failure. The latest ALS guidelines suggest that about 20% of patients with out-of-hospital cardiac arrests experience ventricular tachycardia or ventricular fibrillation [14]. In pre-hospital patients, especially during ventricular tachycardia or ventricular fibrillation, a reduction in the time before AED is applied increases the probability of obtaining ROSC [15]. This finding is consistent with the results of a study conducted only with cardiac arrest patients who had been treated using an AED, and that showed that defibrillation was possible 63.6 ~ 70.8% of the time, and that a high rate ROSC [16,17]. Therefore, early application of an AED to restore appropriate rhythms can achieve ROSC and contribute strongly to the survival rate of pre-hospital cardiac arrest patients. This study also confirmed that intravenous administration of epinephrine increased the likelihood of ROSC before arrival at the emergency room. These findings were found in previous studies [18] that epinephrine injection during out-of-hospital cardiac arrest increases the probability of both ROSC and short-term survival. In general, epinephrine should be injected as soon as possible when arrhythmia does not respond to AED [19]. In another previous study [20], the average time before intravenous injection during cardiac arrest outside the hospital was 19.4 minutes. People who receive injected epinephrine as soon as possible (within 10 min) are approximately 4.52 times more likely to show ROSC than those who receive it late (within 30 min). Therefore, this study suggests that fast acquisition of intravenous access is an important factor that influences ROSC. These findings suggest that rapid treatment by paramedics is needed when pre-hospital cardiac arrest occurs, and that fast and skilled application of intravenous epinephrine is needed. However, paramedics have different proficiencies, so the probability of success applying intravenous epinephrine can vary. Korea is investing time and training for paramedics to secure skillful intravenous access, but the difference in skill levels of paramedics must be corrected. Finally, in this study, intubation increased the probability of ROSC before arrival in the emergency room. The latest ALS guidelines described several approaches to intubation during CPR; they should be applied step-by-step by considering patient factors and rescuer skills [14]. This conclusion implies that a suitable intubation method must be chosen for the patient by considering the skilled teamwork and communication of paramedics. The results of this study confirmed that intubation increased the probability of ROSC, but a previous study [14] suggested that attempting intubation at a pre-hospital site may cause interruption of CPR and may cause harmful hyperventilation. Therefore, the appropriateness of intubation should be discussed in the future. Limitations This study identified the factors affecting the ROSC before arrival in the emergency room by considering data of 2,750 people in one metropolitan area, so the results may not be full applicable to all of Korea. Future Research The results of this study suggest that factors that affect the ROSC before arriving at the emergency room for samples from all over Korea. The various independent variables that were identified to affect ROSC should be verified. The effects of time on spontaneous circulation should be evaluated. For example, the relationship between the time to arrival at the emergency room and the probability of ROSC, and the relationship between the time to achieve intravenous access and the probability of ROSC. Conclusion The results of this study identified that the factors that affect ROSC before arriving at the emergency room include the use of mechanical compression devices, the use of first-aid defibrillators, application of epinephrine, and use of intubation. To increase the probability of ROSC before the patient arrives at the emergency room, the following suggestions shall be made. First, continuous CPR education should be provided for local residents. CPR education is being provided by region in Korea, but has not been implemented for the entire community. Therefore, expansion of the population and national support may improve the CPR capabilities of local residents. Increase in the number of emergency rooms is also necessary; this number tends to be proportional to the population, so their availability may be limited for residents who live in the outskirts of cities. Abbreviations ROSC: Recovery of spontaneous circulation; DMC: Daegu Metropolitan City, CPR: Cardiopulmonary resuscitation; AED: Automated External Defibrillator; ALS : Advance life support Declarations Acknowledgements We would like to acknowledge DMC Fire Department for providing data for this study. Authors’ contribution HSW participated in the conception and design of the research. HSW and JHO acquired and analyzed the data. HSW and JHO interpreted the results. HSW wrote the manuscript. All authors read the manuscript. Availability of data and materials The datasets generated during and analysed during the current study are not publicly available due to agency requests and personal privacy but are available from the corresponding author on reasonable request. Ethics approval and consent to participate The study was conducted in accordance with the international guidelines for human research protection as Declaration of Helsinki and was approved by the Institutional Review Board of the Kyungil University, Gyeongsan, Korea. (IRB No. 1041459-202103-HR-003-01) with the waiver of informed consent. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests Author details 1 Hyun-Ok Jung (First Author, ORCID:0000-0001-8502-0745), Psychiatric Mental Health Advanced Practice Nurse, Ph.D, Sangju of Correctional Institute, Korea, 130, Mokga 2-gil, Sabeol-myeon, Sangju-si, Gyeongsangbuk-do, 37123 Korea, [email protected] 2 Seung-Woo Han (Corresponding Author, ORCID:0000-0001-9144-3285) Assistant professor, Ph.D, Department of Emergency Medical Technology, Kyungil University. Gamasilgil Hayangeup, Gyeongbuk 38428 Korea, email: [email protected] Tel:82-53-600-5691 , Fax:82-53-600-5699 References Statistics Korea. Annual report on domestic statistics by topic 2021. Retrieved from: https://kosis.kr/statisticsList/statisticsListIndex.do?menuId=M_01_01&vwcd=MT_ZTITLE&parmTabId=M_01_01&outLink=Y&entrType= Webner D, Duprey KM, Drezner JA., Cronholm P, Roberts WO. Sudden cardiac arrest and death in United States Marathons. Med Sci Sports Exerc. 2012;44(10):1843-5. doi: 10.1249/MSS.0b013e318258b59a Marijon E, Uy-Evanado A, Dumas F, Karam N, Reinier K, Teodorescu C, Narayanan K, Gunson K, Jui j, jouven X, Chugh SS. Warning symptoms are associated with survival from sudden cardiac arrest. Ann Intern Med. 2016;164(1):23-9. doi: 10.7326/M14-2342 Centers for Disease Control and Prevention. 2006-2017 Survey statistics for acute cardiac arrest, Issued by: Disease prevention center for chronic diseases. PHWR. 2018;11(51):1-34. 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Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004;110(21):3385-97. doi: 10.1161/01.CIR.0000147236.85306.15. Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, Bossaert LL, Brett SJ, Chamberlain D, de Caen AR, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation”. Circulation. 2015;132(13):1286-300. doi: 10.1161/CIR.0000000000000144. Wang PL, Brooks SC. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev.2018;8(8):CD007260.doi:10.1002/14651858.CD007260.pub4 Lee HJ. 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Every one-minute delay in EMS on-scene resuscitation after out-of-hospital pediatric cardiac arrest lowers ROSC by 5%. Resuscitation Plus. 2021;5:100062.doi:10.1016/j.resplu.2020.100062 Lee JS, Lee HP, Shon YD, Ahn HC, Ko BY, Wang SJ. The study of an automated external defibrillator (AED) use by 119 rescuers in Gyeonggi-do.J Korean Soc Emerg Med. 2008;19(1):15-21. Lee HH, Seo KS, Chung JM, Park JB, Ryoo HW, Kim JK, et al. Study of out-of-hospital cardiac arrest patients for whom 119 rescuers used an automated external defibrillator in the metropolitan area. J Korean Soc Emerg Med. 2008;19(1):245-52. Chiang WC, Chen SY, Ko PCI, Hsieh MJ, Wang HC, Huang EPC, Yang CW, Chong KM, Chen WT, Chen SY, et al. Prehospital intravenous epinephrine may boost survival of patients with traumatic cardiac arrest: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2015;23(1):1-7. Hansen M, Schmicker RH, Newgard CD, Grunau B, Scheuermeyer F, Cheskes S, Vithalani V, Alnaji F, Rea T, Idris AH, et al. Time to epinephrine administration and survival from nonshockable out-of-hospital cardiac arrest among children and adults. Circulation. 2018;137(19):2032–40. doi: 10.1161/CIRCULATIONAHA.117.033067 Mauch J, Ringer SK, Spielmann N, Weiss M. Intravenous versus intramuscular epinephrine administration during cardiopulmonary resuscitation: a pilot study in piglets . Pediatr Anaesth. 2013;23(10):906-12. doi: 10.1111/pan.12149 Tables Table 1. General characteristics of out-of-hospital cardiac arrest patients Characteristics Categories Frequency % Occurrence type Disease 1879 90.3 Anything other than disease 202 9.7 Place of occurrence House (parking lot, yard) 2034 86.9 In an ambulance 99 4.2 Nursing institution (medical facility) 101 4.3 Other 106 4.6 Was the cardiac arrest witnessed? Witnessed 722 26.3 Not witnessed 1922 69.9 Unknown 106 3.8 Was CPR performed? Performed 963 35.9 Not performed 1696 63.2 Unknown 25 0.9 Was a mechanical compression device used? Used 856 39.6 Not used 1307 60.4 Was a first-aid defibrillator used? Used 223 8.1 Not used 2527 91.9 Was epinephrine administered intravenously? Secured 380 31.7 Not secured 819 68.3 Was intubation performed? Performed 504 42.0 Not performed 695 58.0 Was spontaneous circulation recovered? Yes 187 14.3 No 1120 85.7 Table 2. The characteristics related to ROSC Categories Spontaneous recovery of circulation χ2 ( P ) Yes No Acute cardiac arrest occurrence type Disease 159 852 0.016 (0.850) Anything other than disease 9 46 Place of occurrence House (parking lot, yard) 101 742 0.707 (0.872) In an ambulance 13 81 Nursing institution (medical facility) 6 57 Other 7 47 Was the cardiac arrest witnessed? Witnessed 122 490 29.7327 (0.001) Not witnessed 60 583 Unknown 5 47 Was CPR performed? Performed 117 616 6.232 (0.044) Not performed 57 450 Unknown 1 14 Was a mechanical compression device used? Used 61 795 95.60596 (0.001) Not used 107 281 Was a first-aid defibrillator used? Used 89 132 146.241 (0.001) Not used 98 988 Was epinephrine administered intravenously? Secured 87 291 25.364 (0.001) Not secured 13 189 Was intubation performed? Secured 80 422 4.456 (0.052) Not secured 20 58 Table 3. Factors influencing the ROSC Characteristics Categories B Odds ratio 95% CI p Occurrence type Disease -0.18 0.84 0.159~4.430 0.836 Anything other than disease 1.00 1.00 Place of occurrence House (parking lot, yard) 0.70 2.01 0.04~50.73 0.305 In an ambulance -0.05 0.96 Nursing institution (medical facility) 1.35 3.86 Other 1.00 1.00 Was the cardiac arrest witnessed? Witnessed 1.41 4.09 0.19~41.73 0.577 Not witnessed 0.66 1.93 Unknown 1.00 1.00 Was CPR performed? Performed -3.68 0.03 0.1~1.59 0.083 Not performed -3.55 0.03 Unknown 1.00 1.00 Was a mechanical compression device used? Used -1.70 0.18 0.08~0.40 0.001 Not used 1.00 1.00 Was a first-aid defibrillator used? Used 1.14 3.13 1.40~6.99 0.005 Not used 1.00 1.00 Was epinephrine administered intravenously? Secured 1.88 6.57 2.16~19.53 0.001 Not secured 1.00 1.00 Was intubation performed? Secured 0.60 1.82 1.04~3.19 0.001 Not secured 1.00 1.00 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-393200","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":21415098,"identity":"a8ce025e-d167-444d-94e8-da096ea58d8d","order_by":0,"name":"Hyun-Ok Jung","email":"","orcid":"","institution":"Sangju of Correctional Institute","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hyun-Ok","middleName":"","lastName":"Jung","suffix":""},{"id":21415099,"identity":"9b2deb94-7487-4644-add4-393e528c809e","order_by":1,"name":"Seungwoo Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIie3RMUsDMRQH8IRbz7r2qP0IwpWDgqD3WS48OJdWBxehYFOEuFT3foubjo45MmQJuEnhlh6Ce7c61eSuk5C4Fsx/fLxf/oGHkI/PSQY3HIUIUwTVdkfbyYK7SRAfSQ6jVUeoIX03MWtoMh6c0W7mJL0PgcTjRTosZJ4Nbtbp3eWLoByvr59sJKoBVSqEpFCfPJkqeBgroonKrS1xfc8rGgak2OQZTFlASm4IEw6iW2g412QSiys2J+V7Y8jhLyIMGT3rx0m5aVu4lUQdkclKfQF+ZVIT3UIYRNRCejXgZrGcDd8kyP03m+mP3TbbHUvPbS3tCfDy9zSz7h8J2rs2fHx8fP59fgCnhG7gUJfYJQAAAABJRU5ErkJggg==","orcid":"","institution":"Kyungil University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Seungwoo","middleName":"","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2021-04-04 09:29:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-393200/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-393200/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13686756,"identity":"f2862b19-a899-4bf1-a4b0-9668c88680ae","added_by":"auto","created_at":"2021-09-17 12:17:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":339939,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-393200/v1/e80cd729-2325-4ef3-9a8a-90ddfbf05dbb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFactors That Affect Recovery of Spontaneous Circulation by Patients With Cardiac Arrest Before Arrival at a Hospital in Daegu Metropolitan City, South Korea\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThe death rate by Cardiovascular system\u0026nbsp;disease in South Korea was 117.4 per 100,000 people in 2019.[1]. Sudden cardiac arrest\u0026nbsp;(SCA) results in death with hemodynamic failure if the heart is not\u0026nbsp;restarted within minutes [2]. In the United States, more than 550,000 patients suffer SCA each year before and during hospitalization, and SCA accounts for more than half of cardiovascular mortality,\u0026nbsp;and is therefore a major concern for national interest and prevention [3]. The recovery rate of patients with cardiac arrest before arrival at the hospital in Korea increased by about 7 times from 1.1% in 2007 to 7.6% in 2017, but compared to advanced countries such as the US 11.4%, Sweden 14.0%, and Norway 13.0%, the rate is still very low [4, 5]. To solve\u0026nbsp;the practical problems of emergency medical treatment, the Korean government has been actively studying the prevention and management of diseases by establishing cardiovascular and cerebrovascular prevention centers to consider the characteristics of each disease in Korea.\u003c/p\u003e\n\u003cp\u003eDaegu Metropolitan City (DMC) in southeastern Korea has\u0026nbsp;the fourth-largest population (2.4 million) in the country. The number of emergency room deaths among emergency-room users in DMC\u0026nbsp;was 0.418%, which was the highest in the country, but the death rate before arrival in the emergency room was 0.05%, which was the lowest in the country\u0026nbsp;[7].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsidering the these opposing characteristics in the emergency medical situations\u0026nbsp;in DMC, the factors that influence\u0026nbsp;Return of Spontaneous Circulation (ROSC) in patients with cardiac arrest in pre-hospital, where and rapid response is required, may contribute to improvement of community participation and emergency care. Previous studies have shown that pre-emergency factors that are closely related to patient survival rate include whether the cardiac arrest patient was witnessed, whether witnesses performed CPR, whether electrocardiogram rhythm\u0026nbsp;was defibrillable, and whether the ROSC occurred spontaneously [8,9]. However, the factors that affect ROSC have not been studied in depth by country or region. This\u0026nbsp;lack occurs\u0026nbsp;because the environment and resources of emergency medical care in each country are different, so the rapid treatment and methods of coping with patients who have pre-hospital cardiac arrest may also differ.\u003c/p\u003e\n\u003cp\u003eRather than identifying the theoretically known factors that affect the ROSC, this study focuses on patient data applied by actual paramedic,\u0026nbsp;and identifies factors that influence\u0026nbsp;ROSC\u0026nbsp;in the region in a practical and multifaceted manner, and thereby contributes\u0026nbsp;to development of emergency medical services.\u0026nbsp;Therefore, the goal of this study was to identify factors that can improve ROSC rate of pre-hospital cardiac arrest patients, and thereby provide basic data that can be exchanged\u0026nbsp;between countries and contribute to development of\u0026nbsp;emergency medical systems\u0026nbsp;beyond the local community\u003c/p\u003e\n\u003cp\u003eThe purpose of this study is to determine whether patients with cardiac arrest recovered\u0026nbsp;their\u0026nbsp;circulation spontaneously\u0026nbsp;before arriving at an emergency room in DMC\u0026nbsp;in 2019, and to determine the factors that affected\u0026nbsp;this\u0026nbsp;recovery. The specific purposes\u0026nbsp;were: To identify\u0026nbsp;whether or not spontaneous circulation is restored before a patient arrives\u0026nbsp;at the emergency room, and to identify factors that affect ROSC\u0026nbsp;before a patient\u0026rsquo;s\u0026nbsp;arrival in the emergency room.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study considered\u0026nbsp;data from patients with cardiac arrest treated by 119 paramedics from January 1, 2019 to December 31, 2019 in DMC. For data collection, the purpose and suitability of the study was explained to the head of the DMC\u0026nbsp;Fire Department, and the use of the data was\u0026nbsp;approved.\u003c/p\u003e\n\u003cp\u003eThe emergency\u0026nbsp;activity log and the details of the cardiopulmonary arrest detailed situation table were anonymized. The total number of cardiac arrest procedures during the target period was\u0026nbsp;2750. Among them, 1307 cases were selected for the ROSC;\u0026nbsp;cases\u0026nbsp;for which CPR was withheld or suspended by medical guidance of paramedics due to apparent death or other causes, were not considered.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study selected and investigated items that are estimated to have an effect on ROSC, as suggested\u0026nbsp;by the emergency-activity log and the detailed cardiopulmonary arrest schedule prepared by 119 paramedics.\u003c/p\u003e\n\u003cp\u003eThe dependent variables were the ROSC of cardiac arrest patients;\u0026nbsp;independent variables were the Type of occurrence, Place of occurrence, Whether the cardiac arrest was witnessed, Whether CPR was performed, Whether a\u0026nbsp;mechanical compression device was used,\u0026nbsp;Whether a first-aid defibrillator was used, Whether epinephrine had\u0026nbsp;been administered intravenously,\u0026nbsp;and Whether intubation\u0026nbsp;was performed.\u003c/p\u003e\n\u003cp\u003eSpecifically, ROSC\u0026nbsp;was defined as (yes\u0026nbsp;=\u0026nbsp;1, no\u0026nbsp;=\u0026nbsp;2). The codes for independent variables were:\u0026nbsp;Type of occurrence (disease = 1, non-disease = 2), Place of occurrence (house = 1, ambulance = 2, nursing institution (medical facility) = 3, other = 4), Whether the cardiac arrest was witnessed (Witnessed = 1, not witnessed = 2, unknown = 3), Whether CPR was performed\u0026nbsp;(performed = 1, not performed = 2, unknown = 3), Whether a mechanical compression device was used\u0026nbsp;(Used = 1, not used = 2), Whether a first-aid defibrillator was used (Used = 1, Not used = 2), Whether epinephrine had been administered intravenously\u0026nbsp;(Secured = 1, Not secured = 2), and Whether\u0026nbsp;intubation\u0026nbsp;was\u0026nbsp;performed\u0026nbsp;(Performed = 1, Not performed = 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, IBM SPSS/WIN 23.0 Program was used for data analysis. Frequency analysis\u0026nbsp;was used to quantify the general characteristics of the subjects,\u0026nbsp;and Chi-squared\u0026nbsp;analysis was conducted to analyze whether the subjects showed ROSC\u0026nbsp;before arriving at the emergency room. Binary Logistic Regression Analysis was conducted\u0026nbsp;to identify factors that affected ROSC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data in this study were approved and obtained from the emergency activity log and cardiopulmonary arrest detailed situation chart prepared by 119 paramedics at the DMC\u0026nbsp;Fire Department, and obtained approval from\u0026nbsp;K\u0026nbsp;University Institutional Review Board (IRB) for the exemption of deliberation (IRB- 1041459-202103-HR-003-01).\u003c/p\u003e"},{"header":"Results","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003e General characteristics of out-of-hospital cardiac arrest patients\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eOf the patients, 90.3%\u0026nbsp;had a disease.\u0026nbsp;Home (86.9%) has the most frequent place of occurrence.\u0026nbsp;Most of the cardiac arrests\u0026nbsp;were not witnessed (69.9%),\u0026nbsp;and CPR was usually not performed\u0026nbsp;(63.2%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMechanical compression devices were generally not used\u0026nbsp;(60.4%), and first-aid defibrillators were generally not used\u0026nbsp;(91.9%).\u0026nbsp;Epinephrine was generally not administered intravenously\u0026nbsp;(68.3%), and intubation\u0026nbsp;was generally not performed\u0026nbsp;(58.0%) (Table 1).\u003c/p\u003e\n\u003col start=\"2\"\u003e\n\u003cli\u003e\u003cstrong\u003e Whether ROSC occurred before arriving at the emergency room according to characteristics related to the occurrence\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eSROC before arriving at the emergency room was statistically more probable if the cardiac arrest was witnessed\u0026nbsp;(\u0026chi;2\u0026nbsp;=\u0026nbsp;29.727, P\u0026nbsp;\u0026lt;\u0026nbsp;0.001), if CPR was performed\u0026nbsp;(\u0026chi;2\u0026nbsp;=\u0026nbsp;6.232, P\u0026nbsp;=\u0026nbsp;0.044),\u0026nbsp;if a mechanical compression device was used\u0026nbsp;(\u0026chi;2\u0026nbsp;=\u0026nbsp;95.596, P\u0026nbsp;\u0026lt;\u0026nbsp;0.001),\u0026nbsp;if a first-aid defibrillator was used\u0026nbsp;(\u0026chi;2\u0026nbsp;=\u0026nbsp;146.241, P\u0026nbsp;\u0026lt;\u0026nbsp;0.001), and if intravenous access was secured\u0026nbsp;(\u0026chi;2\u0026nbsp;=\u0026nbsp;25.364, P\u0026nbsp;\u0026lt;0.001)\u0026nbsp;(Table 2).\u003c/p\u003e\n\u003col start=\"3\"\u003e\n\u003cli\u003e\u003cstrong\u003eFactors that influenced\u0026nbsp;ROSC\u0026nbsp;before arrival at the emergency room\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThis study confirmed that the factors that affect ROSC\u0026nbsp;before arrival at the emergency room were:\u0026nbsp;use of a mechanical compression device, use of a first-aid defibrillator, administration of epinephrine, and use of intubation.\u0026nbsp;Compared to cases in which the method\u0026nbsp;was not used,\u003c/p\u003e\n\u003cp\u003eROSC was reduced to 0.82 times when a mechanical compression device was used compared to when it was not used (95% CI\u0026nbsp;=\u0026nbsp;0.60\u0026nbsp;~\u0026nbsp;0.92); 3.13 times higher when an electrical defibrillator was used\u0026nbsp;(95% CI\u0026nbsp;=\u0026nbsp;1.40\u0026nbsp;~\u0026nbsp;6.99);\u0026nbsp;6.57 times higher when intravenous access\u0026nbsp;was used\u0026nbsp;(95% CI\u0026nbsp;=\u0026nbsp;2.16\u0026nbsp;~\u0026nbsp;19.53), and 1.82\u0026nbsp;times when intubation\u0026nbsp;was used (95% CI\u0026nbsp;=\u0026nbsp;1.04~3.19) (Table 3).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study confirmed that the use of a mechanical compression device affects the probability of ROSC\u0026nbsp;before the patient arrives\u0026nbsp;at the emergency room. These findings show that use of a mechanical compression device was less effective than manual CPR in achieving ROSC.\u0026nbsp;This result contradicts a prior study [11], which showed that mechanical compression devices were more effective than CPR in achieving ROSC, and with a review\u0026nbsp;of 1,187 systems\u0026nbsp;[12],\u0026nbsp;which showed no significant difference between mechanical compression devices and hand CPR in achieving ROSC. This conflicting finding may be a result of the situational environment of the country, because paramedics in Korea they tend to prefer hand CPR over mechanical compression unless the ambulance ride is long. In addition, mechanical compression devices are not always available in ambulances\u0026nbsp;nationwide\u0026nbsp;in Korea. These observations indicate that active research and preparation for the use of mechanical compression devices is necessary in Korea. To increase the efficiency of the use of mechanical compression devices, appropriate training on teamwork and the use of these machines should be provided, but the difference in education level and scope of work for each paramedic raises another practical problem.\u003c/p\u003e\n\u003cp\u003eThis study\u0026nbsp;determined that use of a first aid defibrillator increased the ROSC\u0026nbsp;by 3.13 times. A previous study\u0026nbsp;[13] suggested that improvement of the quality of CPR and the availability of\u0026nbsp;AEDs\u0026nbsp;can improve the probability\u0026nbsp;that a patient will survive heart failure. The latest ALS\u0026nbsp;guidelines\u0026nbsp;suggest that about 20% of patients with out-of-hospital cardiac arrests experience ventricular tachycardia or ventricular fibrillation [14]. In pre-hospital patients, especially during ventricular tachycardia or ventricular fibrillation, a reduction in the time before AED\u0026nbsp;is applied increases the probability of obtaining ROSC [15]. This finding is consistent with the results of a study conducted only with cardiac arrest patients who had been treated using an AED, and that showed that defibrillation was possible 63.6\u0026nbsp;~\u0026nbsp;70.8%\u0026nbsp;of the time, and\u0026nbsp;that a high rate ROSC [16,17]. Therefore, early application of\u0026nbsp;an AED to restore appropriate rhythms can achieve ROSC and contribute strongly to the survival rate of pre-hospital cardiac arrest patients.\u003c/p\u003e\n\u003cp\u003eThis study\u0026nbsp;also\u0026nbsp;confirmed that\u0026nbsp;intravenous administration of epinephrine increased\u0026nbsp;the likelihood of\u0026nbsp;ROSC\u0026nbsp;before arrival at the emergency room. These findings were found in previous studies [18] that epinephrine injection during out-of-hospital cardiac arrest increases the probability of both ROSC\u0026nbsp;and short-term survival. In general, epinephrine should be injected as soon as possible when arrhythmia does not respond to AED [19]. In another previous study [20], the average time before\u0026nbsp;intravenous injection during cardiac arrest outside the hospital was 19.4 minutes. People who receive injected epinephrine as soon as possible (within 10 min) are approximately 4.52 times more likely to show ROSC than those who receive it late (within 30 min). Therefore, this study suggests that fast acquisition\u0026nbsp;of intravenous access\u0026nbsp;is an important factor that influences\u0026nbsp;ROSC.\u0026nbsp;These findings suggest that rapid treatment by paramedics is needed when pre-hospital cardiac arrest\u0026nbsp;occurs,\u0026nbsp;and that fast and skilled application of intravenous epinephrine is needed. However, paramedics\u0026nbsp;have different proficiencies, so the probability of success applying intravenous epinephrine can vary. Korea is\u0026nbsp;investing time and training for paramedics to secure skillful\u0026nbsp;intravenous access, but the difference in skill levels\u0026nbsp;of paramedics\u0026nbsp;must be corrected. Finally, in this study, intubation increased the probability of ROSC\u0026nbsp;before arrival in the emergency room. The latest ALS guidelines\u0026nbsp;described several approaches to intubation\u0026nbsp;during CPR; they should be applied step-by-step by considering patient factors and rescuer skills [14]. This conclusion implies that a suitable intubation method must be chosen for the patient by considering the skilled teamwork and communication of paramedics. The results of this study\u0026nbsp;confirmed that\u0026nbsp;intubation\u0026nbsp;increased the probability of ROSC, but a previous study\u0026nbsp;[14] suggested that attempting intubation at a pre-hospital site may cause\u0026nbsp;interruption of CPR and may cause harmful hyperventilation. Therefore, the appropriateness of intubation should be discussed in the future.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study identified the factors affecting the ROSC\u0026nbsp;before arrival in the emergency room by considering data of 2,750 people in one metropolitan area, so the results may not be full applicable to all of Korea.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFuture Research\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study\u0026nbsp;suggest that factors that affect the ROSC\u0026nbsp;before arriving at the emergency room for samples from all over Korea. The various independent variables that were identified to affect ROSC should be verified.\u003c/p\u003e\n\u003cp\u003eThe effects of time on spontaneous circulation\u0026nbsp;should be evaluated. For example, the relationship between the time to arrival at the emergency room and the probability of ROSC, and the relationship between the time to achieve intravenous access and the probability of ROSC.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study identified that the factors that affect ROSC\u0026nbsp;before arriving at the emergency room include the use of mechanical compression devices, the use of first-aid defibrillators, application of epinephrine, and use of intubation. To increase the probability of ROSC\u0026nbsp;before the patient arrives\u0026nbsp;at the emergency room,\u0026nbsp;the following suggestions shall be made. First, continuous CPR education should be provided for local residents. CPR education is being provided by region in Korea, but has not been implemented\u0026nbsp;for the entire community. Therefore, expansion of the population and national support may improve the CPR capabilities of local residents. Increase in the number\u0026nbsp;of emergency rooms is also necessary; this number tends\u0026nbsp;to be proportional\u0026nbsp;to the population, so their availability may be limited for residents who live\u0026nbsp;in the outskirts of cities.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eROSC: Recovery of spontaneous circulation; DMC: Daegu Metropolitan City, CPR: Cardiopulmonary resuscitation; AED: Automated External Defibrillator; \u003cstrong\u003eALS\u003c/strong\u003e: Advance life support\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge DMC\u0026nbsp;Fire Department for providing data for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHSW participated in the conception and design of the research. HSW and JHO acquired and analyzed the data. HSW and JHO interpreted the results. HSW wrote the manuscript. All authors read the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and analysed during the current study are not publicly available due to agency requests and personal privacy but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the international guidelines for human research protection as Declaration of Helsinki and was approved by the Institutional Review Board of the Kyungil University, Gyeongsan, Korea. (IRB No. 1041459-202103-HR-003-01) with the waiver of informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eHyun-Ok Jung (First Author, ORCID:0000-0001-8502-0745), Psychiatric Mental Health Advanced Practice Nurse, Ph.D, Sangju of Correctional Institute, Korea, 130, Mokga 2-gil, Sabeol-myeon, Sangju-si, Gyeongsangbuk-do, 37123 Korea, [email protected]\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eSeung-Woo Han (Corresponding Author, ORCID:0000-0001-9144-3285) Assistant professor, Ph.D, Department of Emergency Medical Technology, Kyungil University. Gamasilgil Hayangeup, Gyeongbuk 38428 Korea, email:[email protected] \u003ca href=\"Tel:82-53-600-5691\"\u003eTel:82-53-600-5691\u003c/a\u003e, Fax:82-53-600-5699\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStatistics Korea. Annual report on domestic statistics by topic 2021. Retrieved from: \u003cbr /\u003e https://kosis.kr/statisticsList/statisticsListIndex.do?menuId=M_01_01\u0026amp;vwcd=MT_ZTITLE\u0026amp;parmTabId=M_01_01\u0026amp;outLink=Y\u0026amp;entrType=\u003c/li\u003e\n\u003cli\u003eWebner D, Duprey KM, Drezner JA., Cronholm P, Roberts WO. Sudden cardiac arrest and death in United States Marathons. Med Sci Sports Exerc. 2012;44(10):1843-5.\u0026nbsp;doi: 10.1249/MSS.0b013e318258b59a\u003c/li\u003e\n\u003cli\u003eMarijon E, Uy-Evanado A, Dumas F, Karam N, Reinier K, Teodorescu C, Narayanan K, Gunson K, Jui j, jouven X, Chugh SS. Warning symptoms are associated with survival from sudden cardiac arrest. Ann Intern Med. 2016;164(1):23-9. doi:\u0026nbsp;10.7326/M14-2342\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. 2006-2017 Survey statistics for acute cardiac arrest, Issued by: Disease prevention center for chronic diseases. PHWR. 2018;11(51):1-34.\u003c/li\u003e\n\u003cli\u003eRoger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, et al. Heart disease and stroke statistics\u0026mdash;2012 update: a report from the American Heart Association. Circulation. 2012;125(1):1-219. doi:10.1161/CIR.0b013e31823ac046\u003c/li\u003e\n\u003cli\u003eStatistics Korea. Annual report on the population statistics 2021. Retrieved\u0026nbsp;from: \u003cbr /\u003ehttps://kosis.kr/statHtml/statHtml.do?orgId=202\u0026amp;tblId=DT_202N_B4\u0026amp;conn_path=I2\u003c/li\u003e\n\u003cli\u003eKorean National Legal Information Center. Law on emergency medical services 2019. Retrieved\u0026nbsp;from:http://www.law.go.kr/LSW/eng/engLsAstSc.do?menuId=1\u0026amp;dataCls=lsAstSc\u0026amp;cptOfiCd=1352000#cptOfi1352000\u003c/li\u003e\n\u003cli\u003eJacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D\u0026rsquo;Este K, Finn J, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation. 2004;110(21):3385-97. doi: 10.1161/01.CIR.0000147236.85306.15.\u003c/li\u003e\n\u003cli\u003ePerkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, Bossaert LL, Brett SJ, Chamberlain D, de Caen AR, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation\u0026rdquo;. Circulation. 2015;132(13):1286-300. doi: 10.1161/CIR.0000000000000144.\u003c/li\u003e\n\u003cli\u003eWang PL, Brooks SC. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev.2018;8(8):CD007260.doi:10.1002/14651858.CD007260.pub4\u003c/li\u003e\n\u003cli\u003eLee HJ. The effect of a mechanical chest compressions for out-of-hospital advanced cardiac life support. J Converg Inf Technol.\u0026nbsp;2019;9(11):227-33. doi:10.22156/CS4SMB.2019.9.11.227\u003c/li\u003e\n\u003cli\u003eBrooks SC, Hassan N, Bigham BL, Morrison LJ. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev. 2014;27(2):CD007260. doi: 10.1002/14651858.CD007260.pub3.\u003c/li\u003e\n\u003cli\u003eViereck S, M\u0026oslash;ller TP, Ersb\u0026oslash;ll AK, Folke F, Lippert F. Effect of bystander CPR initiation prior to the emergency call on ROSC and 30 day survival: an evaluation of 548 emergency calls. Resuscitation. 2017;111:55-61. doi:10.1016/j.resuscitation.2016.11.020\u003c/li\u003e\n\u003cli\u003eSoar J, Deakin C, Lockey A, Nolan J, Perkins G. 2015 Resuscitation Guidelines,1-36. Retrieved\u0026nbsp;from: https://www.resus.org.uk/library/2015-resuscitation-guidelines/guidelines-adult-advanced-life-support\u003c/li\u003e\n\u003cli\u003eBanerjee P, Ganti L, Stead T., Vera A E, Vittone R, Pepe PE. Every one-minute delay in EMS on-scene resuscitation after out-of-hospital pediatric cardiac arrest lowers ROSC by 5%. Resuscitation Plus. 2021;5:100062.doi:10.1016/j.resplu.2020.100062\u003c/li\u003e\n\u003cli\u003eLee JS, Lee HP, Shon YD, Ahn HC, Ko BY, Wang SJ. The study of an automated external defibrillator (AED) use by 119 rescuers in Gyeonggi-do.J Korean Soc Emerg Med. 2008;19(1):15-21.\u003c/li\u003e\n\u003cli\u003eLee HH, Seo KS, Chung JM, Park JB, Ryoo HW, Kim JK, et al. Study of out-of-hospital cardiac arrest patients for whom 119 rescuers used an automated external defibrillator in the metropolitan area. J Korean Soc Emerg Med. 2008;19(1):245-52.\u003c/li\u003e\n\u003cli\u003eChiang WC, Chen SY, Ko PCI, Hsieh MJ, Wang HC, Huang EPC, Yang CW, Chong KM, Chen WT, Chen SY, et al. Prehospital intravenous epinephrine may boost survival of patients with traumatic cardiac arrest: a retrospective cohort study. Scand J\u0026nbsp;Trauma Resusc Emerg Med. 2015;23(1):1-7.\u003c/li\u003e\n\u003cli\u003eHansen M, Schmicker RH, Newgard CD, Grunau B, Scheuermeyer F, Cheskes S, Vithalani V, Alnaji F, Rea T, Idris AH, et al. Time to epinephrine administration and survival from nonshockable out-of-hospital cardiac arrest among children and adults. Circulation. 2018;137(19):2032\u0026ndash;40. doi: 10.1161/CIRCULATIONAHA.117.033067\u003c/li\u003e\n\u003cli\u003eMauch J, Ringer SK, Spielmann N, Weiss M. Intravenous versus intramuscular epinephrine administration during cardiopulmonary resuscitation: a pilot study in piglets\u003cem\u003e. \u003c/em\u003ePediatr Anaesth. 2013;23(10):906-12. doi: 10.1111/pan.12149\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;1. General characteristics of out-of-hospital cardiac arrest patients \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"210\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eCategories\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"210\"\u003e\n\u003cp\u003eOccurrence type\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eDisease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1879\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e90.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eAnything other than disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e202\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e9.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"210\"\u003e\n\u003cp\u003ePlace of occurrence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eHouse (parking lot, yard)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e2034\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e86.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eIn an ambulance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eNursing institution (medical facility)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e101\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e106\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"210\"\u003e\n\u003cp\u003eWas the cardiac arrest witnessed?\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eWitnessed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e722\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e26.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eNot witnessed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1922\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e69.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e106\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e3.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"210\"\u003e\n\u003cp\u003eWas\u0026nbsp;CPR performed?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003ePerformed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e963\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e35.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eNot performed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1696\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e63.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e0.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"210\"\u003e\n\u003cp\u003eWas a mechanical compression device\u0026nbsp;used?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eUsed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e856\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e39.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eNot used\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1307\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e60.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"210\"\u003e\n\u003cp\u003eWas a first-aid defibrillator used?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eUsed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e223\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e8.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eNot used\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e2527\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e91.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"210\"\u003e\n\u003cp\u003eWas\u0026nbsp;epinephrine administered intravenously?\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eSecured\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e380\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e31.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eNot secured\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e819\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e68.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"210\"\u003e\n\u003cp\u003eWas intubation\u0026nbsp;performed?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003ePerformed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e504\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e42.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eNot performed\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e695\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e58.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"210\"\u003e\n\u003cp\u003eWas\u0026nbsp;spontaneous circulation recovered?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e187\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e14.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"241\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e1120\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e85.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;2. \u003c/strong\u003e\u003cstrong\u003eThe characteristics related to ROSC\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"173\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"232\"\u003e\n\u003cp\u003eCategories\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"144\"\u003e\n\u003cp\u003eSpontaneous recovery of circulation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026chi;2\u0026nbsp;(\u003cem\u003eP\u003c/em\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"173\"\u003e\n\u003cp\u003eAcute cardiac arrest occurrence type\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eDisease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e159\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e852\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"69\"\u003e\n\u003cp\u003e0.016\u003c/p\u003e\n\u003cp\u003e(0.850)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eAnything other than disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"173\"\u003e\n\u003cp\u003ePlace of occurrence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eHouse (parking lot, yard)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e101\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e742\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e0.707\u003c/p\u003e\n\u003cp\u003e(0.872)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eIn an ambulance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e81\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eNursing institution (medical facility)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"173\"\u003e\n\u003cp\u003eWas the cardiac arrest witnessed?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eWitnessed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e122\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e490\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"69\"\u003e\n\u003cp\u003e29.7327\u003c/p\u003e\n\u003cp\u003e(0.001)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eNot witnessed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e583\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"173\"\u003e\n\u003cp\u003eWas\u0026nbsp;CPR performed?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003ePerformed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e117\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e616\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"69\"\u003e\n\u003cp\u003e6.232\u003c/p\u003e\n\u003cp\u003e(0.044)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eNot performed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e450\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"173\"\u003e\n\u003cp\u003eWas a mechanical compression device used?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eUsed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e795\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"69\"\u003e\n\u003cp\u003e95.60596\u003c/p\u003e\n\u003cp\u003e(0.001)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eNot used\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e107\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e281\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"173\"\u003e\n\u003cp\u003eWas a first-aid defibrillator used?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eUsed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e132\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"69\"\u003e\n\u003cp\u003e146.241\u003c/p\u003e\n\u003cp\u003e(0.001)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eNot used\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e98\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e988\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"173\"\u003e\n\u003cp\u003eWas epinephrine administered intravenously?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eSecured\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e291\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"69\"\u003e\n\u003cp\u003e25.364\u003c/p\u003e\n\u003cp\u003e(0.001)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eNot secured\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e189\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"173\"\u003e\n\u003cp\u003eWas intubation\u0026nbsp;performed?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eSecured\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e422\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"69\"\u003e\n\u003cp\u003e4.456\u003c/p\u003e\n\u003cp\u003e(0.052)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"232\"\u003e\n\u003cp\u003eNot secured\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e58\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. \u003c/strong\u003e\u003cstrong\u003eFactors influencing the ROSC\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"166\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eCategories\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003eOdds \u0026nbsp;ratio\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"91\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\n\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"166\"\u003e\n\u003cp\u003eOccurrence type\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eDisease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e-0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e0.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"91\"\u003e\n\u003cp\u003e0.159~4.430\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"54\"\u003e\n\u003cp\u003e0.836\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eAnything other than disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"166\"\u003e\n\u003cp\u003ePlace of occurrence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eHouse (parking lot, yard)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e0.70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e2.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"91\"\u003e\n\u003cp\u003e0.04~50.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"4\" width=\"54\"\u003e\n\u003cp\u003e0.305\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eIn an ambulance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e-0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e0.96\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eNursing institution (medical facility)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e3.86\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"166\"\u003e\n\u003cp\u003eWas the cardiac arrest witnessed?\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eWitnessed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e4.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"91\"\u003e\n\u003cp\u003e0.19~41.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"54\"\u003e\n\u003cp\u003e0.577\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eNot witnessed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e0.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e1.93\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"166\"\u003e\n\u003cp\u003eWas CPR performed?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003ePerformed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e-3.68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"91\"\u003e\n\u003cp\u003e0.1~1.59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" width=\"54\"\u003e\n\u003cp\u003e0.083\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eNot performed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e-3.55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"166\"\u003e\n\u003cp\u003eWas a mechanical compression device used?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eUsed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e-1.70\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"91\"\u003e\n\u003cp\u003e0.08~0.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"54\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eNot used\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"166\"\u003e\n\u003cp\u003eWas a first-aid defibrillator used?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eUsed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e3.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"91\"\u003e\n\u003cp\u003e1.40~6.99\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"54\"\u003e\n\u003cp\u003e0.005\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eNot used\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"166\"\u003e\n\u003cp\u003eWas epinephrine administered intravenously?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eSecured\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e6.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"91\"\u003e\n\u003cp\u003e2.16~19.53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"54\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eNot secured\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"166\"\u003e\n\u003cp\u003eWas intubation\u0026nbsp;performed?\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eSecured\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e0.60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e1.82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"91\"\u003e\n\u003cp\u003e1.04~3.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"54\"\u003e\n\u003cp\u003e0.001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"183\"\u003e\n\u003cp\u003eNot secured\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"65\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"83\"\u003e\n\u003cp\u003e1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sudden cardiac arrest, Return of spontaneous circulation, Cardiopulmonary resuscitation, South Korea","lastPublishedDoi":"10.21203/rs.3.rs-393200/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-393200/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\u003cp\u003eThis study was conducted to investigate the factors that influence\u0026nbsp;Return of Spontaneous Circulation (ROSC)\u0026nbsp;in patients who suffered cardiac arrest before arriving at the emergency room in DMC, Korea. \u003c/p\u003e\u003cp\u003eMethods\u003c/p\u003e\u003cp\u003eThis study considered data for cardiac arrest patients by 119 paramedics from January 1, 2019 to December 31, 2019 in Daegu.\u0026nbsp;Chi-squared\u0026nbsp;analysis was conducted to analyze whether the subjects showed ROSC before arriving at the emergency room. Binary logic regression analysis was conducted to identify the factors that affect ROSC. \u003c/p\u003e\u003cp\u003eResults\u003c/p\u003e\u003cp\u003eROSC when a mechanical compression device was used was reduced to 0.82 of that when it was not used (95% CI\u0026nbsp;=\u0026nbsp;0.60 ~ 0.92).\u0026nbsp;ROSC was 3.13\u0026nbsp;times higher when a first-aid defibrillator\u0026nbsp;was\u0026nbsp;used than when it was not used\u0026nbsp;(95% CI\u0026nbsp;=\u0026nbsp;1.40\u0026nbsp;~\u0026nbsp;6.99).\u0026nbsp;\u0026nbsp;ROSC was 657 times higher when epinephrine was injected than\u0026nbsp;when it was not injected.\u0026nbsp;Lastly, ROSC was 1.82\u0026nbsp;(95% CI\u0026nbsp;=\u0026nbsp;1.04\u0026nbsp;~\u0026nbsp;3.19) times higher\u0026nbsp;when intubation\u0026nbsp;was used than when it was not used. \u003c/p\u003e\u003cp\u003eConclusion\u003c/p\u003e\u003cp\u003eThis study\u0026nbsp;suggests that continuous CPR education, securing financial support, and expansion of emergency rooms for local residents are necessary.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Factors That Affect Recovery of Spontaneous Circulation by Patients With Cardiac Arrest Before Arrival at a Hospital in Daegu Metropolitan City, South Korea","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-04-16 15:35:48","doi":"10.21203/rs.3.rs-393200/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e473e54c-405d-48e6-a4a7-8ef7f417771f","owner":[],"postedDate":"April 16th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":3687740,"name":"Critical Care \u0026 Emergency Medicine"}],"tags":[],"updatedAt":"2021-06-16T06:14:10+00:00","versionOfRecord":[],"versionCreatedAt":"2021-04-16 15:35:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-393200","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-393200","identity":"rs-393200","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}