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Am J Emerg Med. 2019 Apr;37(4):585-589. doi: 10.1016/j.ajem.2018.06.031. Epub 2018 Jul 9.

Prehospital advanced cardiac life support by EMT with a smartphone-based direct medical control for nursing home cardiac arrest.

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Department of Emergency Medicine, Hanyang University Guri Hospital, Republic of Korea.
Department of Emergency Medicine, Hanyang University Guri Hospital, Republic of Korea. Electronic address:
Department of Emergency Medicine, Soonchunhyang University Hospital, Cheonan, Republic of Korea.
Department of Emergency Medicine, Soonchunhyang University Hospital, Bucheon, Republic of Korea.
Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Republic of Korea.
Department of Emergency Medicine, Gachon University Gil Medical Center, Republic of Korea.
Department of Emergency Medicine, Chosun University Hospital, Gwangju, Republic of Korea.
Department of Emergency Medicine, Myongji Hospital, Republic of Korea.
Department of Emergency Medicine, Dankook University Hospital, Republic of Korea.
Department of Emergency Medicine, Catholic University of Korea, St. Vincent's Hospital, Republic of Korea.



To compare the survival to discharge between nursing home (NH) cardiac arrest patients receiving smartphone-based advanced cardiac life support (SALS) and basic life support (BLS).


The SALS registry includes data on cardiac arrest from 7 urban and suburban areas in Korea between July 2015 and December 2016. We include adult patients (>18) with out-of-hospital cardiac arrest (OHCA) of medical causes and EMS attended and dispatched in. SALS is an advanced field resuscitation including drug administration by paramedics with video communication-based direct medical direction. Prehospital resuscitation method was key exposure (SALS, BLS). The primary outcome was survival to discharge.


A total of 616 consecutive out-of-hospital cardiopulmonary resuscitation cases in NHs were recorded, and 199 (32.3%) underwent SALS. Among the NH arrest patients, the survival discharge rate was a little higher in the SALS group than the BLS group (4.0% vs 1.7%), but the difference was not significant (P = 0.078). Survival discharge with good neurologic outcome rates was 0.5% in the SALS group and 1.0% in the BLS group (P = 0.119). On the other hand, in the non-NH group, all outcome measures significantly improved when SALS was performed compared to BLS alone (survival discharge rate: 10.0% vs 7.3%, P = 0.001; good neurologic outcome: 6.8% vs 3.3%, P < 0.001).


As a result of providing prehospital ACLS with direct medical intervention through remote video calls to paramedics, the survival to discharge rate and that with good neurologic outcome (CPC 1, 2) of non-NH patients significantly improved, however those of NH patients were not significantly increased.


Administration; Advanced cardiac life support; Emergency medical system; Epinephrine; Intravenous; Out-of-hospital cardiac arrest


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