The effect of regional distribution of isolation rooms in emergency departments on ambulance travel time during the COVID-19 pandemic.

OBJECTIVE: The number and distribution of isolation rooms in Korea differ by region. The distribution of isolation beds in emergency departments may have affected ambulance travel time and burden on emergency medical service (EMS) during the COVID-19 pandemic. METHODS: This retrospective observational study analyzed EMS records in four regions of the Gyeonggi Province, Korea, from January 01, 2019 to December 31, 2020. The main exposure was the number of emergency department isolation rooms in each region. The primary outcome was call-to-return time for the EMS. The interaction effect of the number of regional isolation rooms on the call-to-return time during the COVID-19 pandemic was analyzed using a generalized linear model (GLM) and logistic regression. RESULTS: A total of 781,246 cases was included in the analyses. During the COVID-19 pandemic, the call-to-scene time (before 8 minutes vs. after 9 minutes, P<0.05) and call-to-return time (before 46 minutes vs. after 52 minutes, P<0.05) for emergency patients increased significantly compared to before the pandemic. As the number of regional isolation rooms increased, the effect of COVID-19 on the call-to-return time decreased significantly in the multivariable GLM with an interaction term (with 10.14 isolation rooms per million population: adjusted exponential ß coefficient [exp(ß)], 1.33; with 12.24 isolation rooms per million population: adjusted exp(ß), 1.18). As the number of regional isolation rooms increased, the effect of COVID-19 on the call-to-scene time decreased significantly in the multivariable GLM with an interaction term (with 10.14 isolation rooms per million population: adjusted exp(ß), 1.20; with 12.24 isolation rooms per million population: adjusted exp(ß), 1.09). CONCLUSION: During the pandemic, the increases in call-to-return time and call-to-scene time were smaller in regions with more isolation rooms per population.

Monitoring of characteristics of the patients visiting an emergency center in Cameroon through the development of hospital patient database.

Most countries in Sub-Saharan Africa have struggled to utilize health information technology and thus lack in accurate patient data. This paper describes the method of collecting patient data and patient characteristics in an emergency centre in Yaoundé, Cameroon. We developed an Epi InfoTM-based data entry form to collect data of the patients who visited the Centre des Urgences de Yaoundé (CURY) from January 2016 to June 2018. Demographic, clinical symptoms, treatments and outcome data were collected. Additional data on the patients with multiple trauma, chest pain, sepsis/septic shock, and stroke were also collected. During the study period, a total of 18,875 patients' data were collected (44.5% women, median age of 36). Of the total patients, 2.4% had chest pain, 2.7% had stroke, 1.9% had sepsis/septic shock, and 1.6% had multiple trauma. About 6.0% patients received operation and majority of patients were discharged either normally (48.2%) or with continuity of care (26.3%). About 5.0% of patients were transferred to other hospital and 5.2% of patients were dead. This study serves to broaden understanding of the emergency patients in Yaoundé, Cameroon.

Effect of cancer history on post-resuscitation treatments in out-of-hospital cardiac arrest.

OBJECTIVES: There is growing evidence that optimal post-resuscitation treatment is a significant factor for overall survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA). However, there is also growing evidence of disparities in treatments in vulnerable populations such as elderly individuals or patients with underlying diseases, including cancer. AIM: The aim of this study was to evaluate the influence of cancer status on post-resuscitation therapies among OHCA patients. MATERIAL AND METHODS: This was a cross-sectional observational study based on a nationwide prospective OHCA registry database of Korea. All adult OHCA patients with presumed cardiac etiology and sustained return of spontaneous circulation (ROSC) from 2009 to 2016 were included in this study. Main exposure was history of cancer and primary outcome was post-resuscitation care, including percutaneous coronary intervention (PCI) and targeted temperature management (TTM). Multivariable logistic regression was used to analyze the association between cancer and post-resuscitation treatments. RESULTS: A total of 33,760 patients were included for final analysis. Multivariable logistic analysis showed that cancer patients were significantly less likely to receive PCI and TTM compared to those without history of cancer with adjusted odds ratios of 0.29 (95% CI: 0.24-0.37) and 0.66 (0.58-0.77), respectively. CONCLUSION: The results of this study suggest that a prior history of cancer may be associated with lower probability to receive potentially beneficial post-resuscitation treatments.

Long-term survival of out-of-hospital cardiac arrest patients with malignancy.

BACKGROUND: The aim of this study was to investigate whether the 1-year survival rate of out-of-hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy. METHODS: All adult OHCA patients were retrospectively analyzed in a single institution for 6years. The primary outcome was 1-year survival, and secondary outcomes were sustained return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and discharge with a good neurological outcome (CPC 1 or 2). Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were performed to test the effect of malignancy. RESULTS: Among 341 OHCA patients, 59 patients had malignancy (17.3%). Sustained ROSC, survival to admission, survival to discharge and discharge with a good CPC were not different between the two groups. The 1-year survival rate was lower in patients with malignancy (1.7% vs 11.4%; P=0.026). Kaplan-Meier survival analysis revealed that patients with malignancy had a significantly lower 1-year survival rate when including all patients (n=341; P=0.028), patients with survival to admission (n=172, P=0.002), patients with discharge CPC 1 or 2 (n=18, P=0.010) and patients with discharge CPC 3 or 4 (n=57, P=0.008). Malignancy was an independent risk factor for 1-year mortality in the Cox proportional hazard regression analysis performed in patients with survival to admission and survival to discharge. CONCLUSIONS: Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1-year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy.