병원 밖에서 발생한 심인성 심장정지환자의 신경학적 결과 관련 요인 -7년간 국가 심장정지조사사업 자료 활용-

Purpose: The purpose of this study is to examine the factors associated with neurological outcome and to provide ideas for improving the operation of the emergency medical system in Korea. Methods: A total of 95,911 out-of-hospital cardiac arrests (OHCAs) with cardiac etiology who were transported by 119 EMS ambulances for seven years from 2006 to 2012 in Korea were analyzed. According to these data there is a multilevel structure, so that patient`s neurological outcome in the same region is not independent but interrelated, therefore two-level (patient-region) logistic regression analysis was applied to adjust this correlation. Results: The adjusted odds ratio (OR) in the group in which Cardiopulmonary Resuscitation (CPR) was performed by a bystander was 1.27 for good neurological outcome. The adjusted OR in the group with implementation of an automated external defibrillator (AED) before arrival at the hospital was 4.11 for good neurological outcome. The adjusted OR in the numbers of emergency physicians compared with <3 was 2.76 (3-4), 4.24 (≥5) and the adjusted OR in OHCAs volume of each hospital compared with <50 was 2.31 (50-64), 2.51 (65-102), and 2.94 (≥103). The adjusted OR in deprivation level compared with <2 was 0.72 (≥2). Conclusion: The neurological outcome was significantly better in the group in which CPR was performed by a bystander and AED was applied early. The neurological outcome tended to be significantly better in hospitals with higher numbers of emergency physicians and higher volume of OHCAs, in less deprived districts.