• Gi Woon Kim, Hyung Jun Moon, Hoon Lim, Yu Jin Kim, Choung Ah Lee, Yong Jin Park, Kyoung Mi Lee, Jae Hyug Woo, Jin Seong Cho, Won Jung Jeong, Hyuk Joong Choi, Chang Sun Kim, Han Joo Choi, Il Kug Choi, Nam Hun Heo, Jung Soo Park, Young Hwan Lee, Seung Min Park, and Dong Kil Jeong.
• Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea.
• Am J Emerg Med. 2022 Jun 1; 56: 211-217.

PurposeThe aim of this study was to compare out-of-hospital cardiac arrest (OHCA) outcomes before and after implementation of Smart Advanced Life Support (SALS) protocol incorporating changes in cardiopulmonary resuscitation (CPR) assistance and coaching by physicians via real-time video calls.MethodsA prospective before-and-after multi-regional observational study was conducted between January 2014 and December 2018. In January 2016, emergency medical service (EMS) providers adopted an integrated CPR coaching by physicians via real-time video call via SALS to treat patients with OHCA focusing on high-quality cardiopulmonary resuscitation. Propensity score matching was performed to match patients. Patients' outcomes using conventional protocol were then compared with those of patients using the SALS protocol.ResultsAmong 26,349 OHCA cases, 2351 patients and 7261 patients were enrolled during the pre-intervention and the post-intervention periods, respectively. Multivariate analysis showed that SALS was independently associated with favorable neurological outcomes [odds ratio (OR): 2.20; 95% confidence interval (CI): 1.62-2.99]. A total of 2096 patients were propensity score-matched and the two groups were well balanced. In the matched cohort, the use of SALS protocol was still associated with increased prehospital return of spontaneous circulation (ROSC) (OR: 3.83, 95% CI: 2.80-5.26), survival to discharge (OR: 1.68; 95% CI: 1.20-2.34), and favorable neurological outcomes (OR: 1.83; 95% CI: 1.19-2.82).ConclusionA multidisciplinary SALS protocol for the resuscitation of patients with OHCA was associated with increased prehospital ROSC, survival to discharge, and good neurologic outcomes compared with traditional resuscitation protocol.Copyright © 2022 Elsevier Inc. All rights reserved.

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