Unrecognized Out of Hospital Cardiac Arrest Symptoms during Thailand’s Emergency Medical Services

Thanat  Tangpaisarn; Tachaya Srinopparatanakul; Ratchanan Artpru; Praew Kotruchin; Kamonwon  Ienghong; Korakot Apiratwarakul

doi:10.3889/oamjms.2021.6867

Authors

Thanat Tangpaisarn Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand https://orcid.org/0000-0001-5142-5410
Tachaya Srinopparatanakul Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Ratchanan Artpru Emergency medical services unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Praew Kotruchin Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Kamonwon Ienghong Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand https://orcid.org/0000-0003-0328-4128
Korakot Apiratwarakul Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand https://orcid.org/0000-0002-1984-0865

DOI:

https://doi.org/10.3889/oamjms.2021.6867

Keywords:

Emergency medical services, Prehospital emergency care, Cardiac arrest, Out-of-hospital cardiac arrest, Symptoms

Abstract

BACKGROUND: To improve survival rate, the main focus of adult cardiac arrest management includes rapid recognition, prompt administration of cardiopulmonary resuscitation (CPR), defibrillation for shockable rhythms, post-return of spontaneous circulation (ROSC) care, and identification and treatment of underlying causes. This study aimed to identify the determinants of unrecognized cardiac arrest, and to study the recognition rate of out-of-hospital cardiac arrest (OHCA) by emergency medical services call handlers.

METHODS: We included OHCA patients who were transferred to hospital via Emergency Medical Services (EMS) of Srinagarind hospital, Khon Kaen, Thailand, from 1^st January 2020 to 31^st December 2020. The primary outcome was to identify symptoms that lead to an unrecognized cardiac arrest by the EMS call handlers. Secondary outcomes were to identify the recognition rate of OHCA by emergency medical services call handlers, and assess the outcome of CPR performed on OHCA patients.

RESULTS: There were a total of 58 patients in the present study, 26 patients (44.8%) and 32 patients (55.2%) belonged to the unrecognized and recognized cardiac arrest groups, respectively. The most common symptoms that led to unrecognized cardiac arrest were a state of unconsciousness (46.2%), major trauma (15.4%), and seizure-like activity (11.5%). The rate of ROSC was higher in the unrecognized cardiac arrest group (34.6% vs. 15.6%) but the rate of survival to hospital discharge was higher in the recognized cardiac arrest group (6.3% vs 0%).

CONCLUSIONS: Falling unconscious is the most common symptom of unrecognized OHCA cases seen by EMS in Thailand. Basic life support, especially an immediate assessment of a patient’s respiratory status should be taught in health programs in school or through public service channels.

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