Emergency medical service organizational structure and prehospital outcomes after out-of-hospital cardiac arrest in China: Insights from the BASIC-OHCA.

AIM: To compare the prehospital outcomes of out-of-hospital cardiac arrest (OHCA) across different emergency medical service (EMS) system organizational models in China.

METHODS

This is a retrospective analysis of data from the Baseline Investigation of Out-of-Hospital Cardiac Arrest (BASIC-OHCA) (August 1, 2019-December 31, 2020) in China. Two EMS models were compared. One is independent model, in which all stations are directly established and managed by an independent public agency. The other one is hospital-based model, in which the stations are affiliated to hospitals. The primary outcome was ROSC sustained until arrival at the emergency department and transfer of care (survived event). Association were analyzed using multivariable logistic regression.

RESULTS

A total of 24,814 OHCA patients from 10 EMS systems were included. The overall survived event rate was 2.05%, which was higher in the independent model than the hospital-based model (2.23% vs. 1.40%; P < 0.001). After adjustment, the independent model remained associated with higher odds of survived event (adjusted odds ratio 2.32; 95% CI, 1.71-3.17). The independent model had longer EMS response times (median 12.00 vs. 10.00 min; P < 0.001) but higher rates of epinephrine administration (85.02% vs. 73.26%; P < 0.001) and advanced airway placement (49.24% vs. 21.48%; P < 0.001) than the hospital-based model.

CONCLUSIONS

In this study, the independent model was associated with a statistically higher survived event rate than the hospital-based model in China. However, considering the small absolute difference, future efforts should be taken to explore broader, system-level best practices to achieve more clinically meaningful improvements in OHCA outcomes.