The Association Between Mode of Transport and Out-of-Hospital Cardiac Arrest Outcomes in Developing Countries

Introduction: Out-of-hospital cardiac arrest (OHCA) is a critical medical emergency that poses significant global public health concerns. The survival rates for OHCA remain alarmingly low, contributing to as high as 10% of the total mortality in developing countries. This study aimed to analyze survival outcomes of OHCA patients in various developing countries, related to the mode of transport to the Emergency Department (ED). Methods: This study was a retrospective analysis of the Pan-Asian Resuscitation Outcomes Study registry (PAROS) data from 2015-2018. PAROS study is a multi-center cohort study providing baseline information on OHCA epidemiology, management, and outcomes. Data was analyzed from Thailand, China, the Philippines, and Vietnam. The primary outcome was return of spontaneous circulation (ROSC), and the secondary outcome was survival to discharge or 30 days post-arrest. Subgroup analysis was performed within each country. Results: The study included 3,905 patients. 1,945 (49.8%) patients were conveyed by Emergency Medical Services (EMS), 448 (11.5%) by private ambulance, 1,148 (29.4%) by private transport, and 364 (9.32%) by public transport. The public transport group had the lowest ROSC rate at 17.0%, compared to EMS (22.7%), private ambulance (29.0%), and private transport (25.8%). Survival rate was also the lowest for the public transport group at 4.12%, compared to EMS (5.3%), private ambulance (12.5%), and private transport (5.05%). Both ROSC rate and survival outcomes were statistically significant. Subgroup analysis showed a significant relationship between the mode of transport and outcomes for Vietnam and China. Conclusion: In patients with OHCA in various developing countries, the mode of transport is associated with differing ROSC rates and survivability outcomes. More education of EMS services and other prehospital interventions, such as bystander CPR, can be done in these countries to improve outcomes for OHCA patients. Further research can be done to analyze how other prehospital interventions can affect outcomes for OHCA patients in developing countries.