International Journal of Emergency Medicine最新文献

{"title":"Prognostic significance of inferior vena cava volume defined by initial polytrauma CT-imaging: single-center experience of a level-1 trauma center.","authors":"Hans-Jonas Meyer, Veronika Sotikova, Michael Hetz, Georg Osterhoff, Christian Kleber, Timm Denecke, Robert Werdehausen, Gunther Hempel, Manuel F Struck","doi":"10.1186/s12245-024-00752-9","DOIUrl":"10.1186/s12245-024-00752-9","url":null,"abstract":"<p><strong>Background: </strong>The significance of computed tomography (CT)-based volume measurement of the inferior vena cava (IVC) in the treatment and prognosis of trauma patients is not yet fully understood. The conflicting results that have been reported may be attributable to differences in injury severity and the use of different measurement methods, including IVC index and volumetry. The purpose of this study was to determine the relationship between IVC volume and red blood cell (RBC) transfusion and mortality in intubated trauma patients who were stable enough for initial CT imaging.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on all consecutive trauma patients who underwent emergency tracheal intubation and mechanical ventilation before initial whole-body CT imaging at a level-1 trauma center over a 12-year period (2008-2019). The IVC volume was determined on initial trauma CT and included in multivariable models with demographic and diagnostic data. Associations of overall RBC transfusion, massive transfusion, 24-h mortality, and 30-day mortality were assessed using logistic regression analyses and Cox proportional hazard models.</p><p><strong>Results: </strong>A total of 438 patients (75.3% male) with a median age of 50 years, and a median injury severity score (ISS) of 26 points were included in the analysis. Most of the patients (97.5%) had suffered from blunt trauma mechanisms. Median IVC volume was 36.25 cm³, and RBC transfusion and massive transfusion were performed in 197 and 90 patients, respectively. The 24-h and 30-day mortality rates were 7.3% and 23.3%, respectively. VCI volume was found to be independently associated with the necessity of RBC transfusion and 24-h mortality (OR 0.98, 95% CI 0.96-0.99, p = 0.01 and HR 0.96, 95% CI 0.93-0.99, p = 0.025, respectively), while associations with massive transfusion and 30-day mortality were not statistically significant in multivariable analyses.</p><p><strong>Conclusion: </strong>Initial IVC volume may serve as a predictor of patients at risk for overall RBC transfusion requirements and 24-h mortality, suggesting the possibility of its diagnostic efficacy in short-term outcomes. Further studies are needed to confirm these findings.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"160"},"PeriodicalIF":2.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital management and outcomes of patients calling with chest pain as the main complaint.","authors":"Sughra Ahmed, Filip Gnesin, Helle Collatz Christensen, Stig Nikolaj Blomberg, Fredrik Folke, Kristian Kragholm, Henrik Bøggild, Freddy Lippert, Christian Torp-Pedersen, Amalie Lykkemark Møller","doi":"10.1186/s12245-024-00745-8","DOIUrl":"https://doi.org/10.1186/s12245-024-00745-8","url":null,"abstract":"<p><strong>Background: </strong>Chest pain is a frequent cause of health care contacts. We examined the prehospital management, in-hospital discharge diagnoses, and mortality of patients calling a non-emergency and emergency medical service with chest pain.</p><p><strong>Methods: </strong>The Copenhagen Emergency Medical Services (EMS) consists of a non-emergency medical helpline (calls to 1813) and emergency medical service (1-1-2 calls). We included all calls to the Copenhagen EMS with a primary complaint of chest pain from 2014 to 2018 in Copenhagen, Denmark. The outcomes were: emergency response (ambulance dispatch, other transports/self-transport/home visits, self-care, and unknown/cancelled response), in-hospital diagnosis within 7 days after the call (cardiovascular, pulmonary, or other non-cardiovascular/pulmonary) and 30-day mortality.</p><p><strong>Results: </strong>Among 4,834,071 calls, 91,671 were registered with chest pain at the Copenhagen EMS. The first call for each patient was kept for analysis (n = 66,762). In total, 91.4% were referred to the hospital, 75.8% (n = 50,627) received an ambulance and 15.6% (n = 10,383) received other transport/self-transport/home visits. Overall, 26.9% (n = 17,937) were diagnosed with a cardiovascular disease, 5.2% (n = 3,490) a pulmonary disease, 52.8% (n = 35.242) other non-cardiovascular/pulmonary disease, and 15.1% (n = 10,093) received no diagnosis. Among ambulance-transported patients, the prevalence of cardiovascular discharge diagnoses was higher (32.1%) and fewer received no diagnosis (11.0%). Cardiovascular disease was less prevalent among patients not transported by ambulance and patients not referred to hospital at all (2-13.4%) and in patients ≤ 40 years of age (< 10%). The 30-day mortality was below 5% regardless of diagnosis (0.6-4%), and 65,704 (98.4%) were still alive 30 days later.</p><p><strong>Conclusion: </strong>Nearly all patients calling with chest pain were referred for treatment. Among ambulance-transported patients, around half of the patients did not have a cardiovascular/pulmonary disease. While current practices appear reasonable, improved differentiation of chest pain patients in telephone consultations could potentially both improve the treatment and management of these patients and reduce the in-hospital burden of non-acute chest pain consultations.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"158"},"PeriodicalIF":2.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhythm conversion in out-of-hospital cardiac arrest and influence on the return of spontaneous circulation at the hospital arrival: a 10-year retrospective study in Croatia.","authors":"Josip Lovaković, Porin Šantek, Luka Matej Mahečić, Ivana Rožić, Jana Marić, Đivo Čučević, Lorka Tarnovski, Dejana Martinić, Fran Rašić, Žarko Rašić","doi":"10.1186/s12245-024-00746-7","DOIUrl":"10.1186/s12245-024-00746-7","url":null,"abstract":"<p><strong>Background: </strong>While initial non-shockable (NS) rhythms are often associated with poor prognosis, the conversion to shockable rhythms during cardiopulmonary resuscitation (CPR) can significantly influence survival rates. This retrospective cohort study investigated the impact of rhythm conversion on the return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients.</p><p><strong>Methods: </strong>The study analyzed data recorded from January 2012 to August 2022 obtained from the Utstein Templates from The Institute of Emergency Medicine of the City of Zagreb. Statistical analysis, including logistic regression, was performed to assess the likelihood of achieving maintained ROSC.</p><p><strong>Results: </strong>Study included 2791 cases of OHCA with emergency medical service attempts at resuscitation. A total of 74.92% of patients had an initial NS rhythm with a total conversion rate of 18.27%. Factors significantly associated with rhythm conversion were younger age, male sex (74.13%), public place (32.35%) of and witnessed collapse (75.98%), higher adrenaline dose, use of a mechanical compression machine (41.68%), and shorter response interval. There was no significant difference in the occurrence of conversion between the cases with initial asystole and pulseless electrical activity (PEA). However, cases with converted asystole (33.48%) compared to the ones with converted PEA (20.65%) had significantly greater ROSC maintenance (p = 0.006), as well as when compared to cases with sustained PEA (20.93%, p < 0.001). Logistic regression revealed that women with rhythm conversion, lower adrenaline doses, and provided bystander CPR were significantly more likely to achieve ROSC at hospital admission (P < 0.001).</p><p><strong>Conclusions: </strong>This comprehensive study sheds light on the importance of rhythm conversion in patients with OHCA, with greater ROSC achievement, especially in patients with initial asystole, than in patients with initial PEA.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"157"},"PeriodicalIF":2.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11468297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal cerebral thrombosis after pericardiectomy.","authors":"Qin Jiang, Tao Yu, Keli Huang, Bing Huang, Xiang Huang, Shengshou Hu","doi":"10.1186/s12245-024-00729-8","DOIUrl":"10.1186/s12245-024-00729-8","url":null,"abstract":"<p><strong>Background: </strong>Pericardiectomy due to constrictive pericarditis is usually safe procedure. There was a rare event of thrombosis after pericardiectomy, which was mainly accounted by low-cardiac-output syndrome.</p><p><strong>Case presentation: </strong>Here, we report the case undergoing pericardiectomy after constrictive pericarditis, with fatal cerebral thrombosis after pericardiectomy confirmed by endovascular mechanical thrombectomy. Even though recanalization was completed and suggestive decompressive craniectomy was in preparation, the patient still died for cerebral hernia due to severe edema. The causes of cerebral thrombosis after pericardiectomy in this case was accounted by the persistence of nonpliable pericardium encasing the left ventricular wall limited local myocardium motor, pro-coagulable state due to thermal transmission during decortication like radiofrequency ablation under the condition of postoperative atrial fibrillation and rapid ventricular rates precipitated the information of mural thrombus in cardiac cavity and migration into the main branch of the aortic arch.</p><p><strong>Conclusion: </strong>The protocol of prompt aggressive anticoagulation prophylaxis would be vigilantly recommended for the patients undergoing pericardiectomy.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"156"},"PeriodicalIF":2.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11468132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shark fin ECG pattern in a patient with acute ascending aortic dissection.","authors":"Alessio Caccioppola, Filippo Maria Russo, Enrico Molho, Lorenzo Fargione, Alessandro Guareschi, Federico Colombo, Alessandro Jachetti","doi":"10.1186/s12245-024-00732-z","DOIUrl":"10.1186/s12245-024-00732-z","url":null,"abstract":"<p><p>The 'shark-fin' ECG-sign is a rare electrocardiographic pattern seen in ACS, typically associated with poor prognosis. However, its manifestation in acute aortic syndromes remains largely unexplored. Here, we present a case of a patient diagnosed with Ascending Aortic Dissection, who presented to ED with acute chest pain and shark-fin ECG-pattern.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"154"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of convexity non-aneurysmal subarachnoid hemorrhage caused by cerebral sinus thrombosis.","authors":"Ali Abasi, Asra Moradkhani, Shiva Rahimi, Hannah Magrouni","doi":"10.1186/s12245-024-00712-3","DOIUrl":"10.1186/s12245-024-00712-3","url":null,"abstract":"<p><strong>Background: </strong>Convexity subarachnoid hemorrhage (cSAH) is an uncommon presentation of subarachnoid bleeding, referring to bleeding more localized to the convexities of the brain. The diagnosis of cerebral venous sinus thrombosis (CVST) can be difficult especially when patients initially present with cSAH. The authors present a case and then discuss the pathophysiology and management.</p><p><strong>Case presentation: </strong>A 56-year-old woman with a previous history of hypertension and ischemic heart disease presented to the emergency department after experiencing it. Two seizures following a severe headache. The patient's history was negative for recent illnesses, head trauma, history of migraines, smoking, alcohol consumption, or intravenous drug use. The patient was diagnosed with CVST based on magnetic resonance venography (MRV). Genetic studies further identified homozygous mutations in the Prothrombin and MTHFR genes. Anticoagulant therapy was initiated with 60 mg of Enoxaparin twice daily and subsequently transitioned to Warfarin after 48 h continued for 3 months, and then replaced by rivaroxaban.</p><p><strong>Conclusions: </strong>This study highlights the importance of considering CVST as a cause of SAH, emphasizes the role of advanced imaging in diagnosis, and demonstrates a successful treatment approach using both traditional and direct oral anticoagulants. The insights provided in this article can contribute to improving the management of patients with CVST-related SAH.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"155"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of an early attention strategy to reduce emergency room overcrowding in an academic institution in Colombia, a pilot study.","authors":"German Devia Jaramillo, Nathalia Esmeral Zuluaga, Viviana Andrea Velandia Avellaneda, Salvador Menendez Ramirez, Fernando Jose Pimienta Neira, Angie Paola Lopez Contador, Juan Pablo Vargas Gallo","doi":"10.1186/s12245-024-00700-7","DOIUrl":"10.1186/s12245-024-00700-7","url":null,"abstract":"<p><p>Overcrowding is a worldwide problem, and long waiting times are associated with increased morbidity and even mortality of patients regardless of triage classification. Although there are many tools published in the literature that contribute to the reduction of overcrowding, for the Colombian population there are not many tools evaluated to reduce the length of stay of patients in the emergency department. This is a retrospective analytical study that compared whether there was a difference in patient definition time and ED length of stay between a group attended under an early care protocol (PAT) versus the usual protocol. Of the total of 969 patients included it was found that the group attended under the PAT protocol had a shorter definition time than the usual protocol, also the Emergency department length of stay (EDLOS) was significantly lower in the PAT group compared to the usual protocol. The implementation of the PAT protocol performed by emergency physicians allows a faster contact with the patient by the physician, and leads to a significant reduction of EDLOS, contributing to the reduction of overcrowding in the emergency department.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"152"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of advanced trauma life support training on 30-day mortality in severely injured patients at a Kenyan tertiary center: a retrospective matched case-control study.","authors":"Charbel Kamau, Idris Chikophe, Abdulkarim Abdallah, Edwin Mogere","doi":"10.1186/s12245-024-00713-2","DOIUrl":"10.1186/s12245-024-00713-2","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma is a leading cause of mortality worldwide, particularly in low and middle-income countries (LMICs) like Kenya. This study evaluates the impact of Advanced Trauma Life Support (ATLS) training on 30-day mortality outcomes in severely injured patients at a tertiary care center in Kenya.</p><p><strong>Methods: </strong>A retrospective matched case-control study was conducted at Aga Khan University Hospital, Nairobi. The study included adult patients (≥ 18 years) with polytrauma (Injury Severity Score [ISS] > 15) from 2011 to 2022. Propensity score matching was used to pair 81 post-ATLS cases with 81 pre-ATLS controls based on age and ISS. Data analysis was performed using R Statistical language (version 4.3.0).</p><p><strong>Results: </strong>The 30-day mortality rate decreased significantly from 17% (95% CI: 9.4-27.4%) pre-ATLS to 6% (95% CI: 2.0-13.5%) post-ATLS (p = 0.028). No significant differences were found in baseline characteristics between the two groups. Road traffic accidents were the primary cause of trauma in both groups (72% pre-ATLS vs. 78% post-ATLS).</p><p><strong>Conclusion: </strong>ATLS training significantly reduced 30-day mortality in severely injured patients, demonstrating its effectiveness even in resource-limited settings. Further prospective randomized studies are recommended to confirm these findings and evaluate long-term outcomes.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"153"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual flagging failed to identify pseudohyperkalemia in acute myeloid leukemia: case report.","authors":"Yangming Cao","doi":"10.1186/s12245-024-00734-x","DOIUrl":"10.1186/s12245-024-00734-x","url":null,"abstract":"<p><strong>Background: </strong>Pseudohyperkalemia is well known in acute or chronic lymphocytic leukemia, but it is very rare in acute myeloid leukemia (AML). The lab flagging system for leukocytosis to prevent pseudohyperkalemia may not work.</p><p><strong>Case presentation: </strong>A 55 year-old white man with AML was sent to emergency department for transfusion due to severe anemia. Blood test showed severe leukocytosis and elevated potassium. Repeated blood test showed his potassium was even higher. Anti-hyperkalemic medical treatment was given. He was then diagnosed with pseudohyperkalema.</p><p><strong>Investigation: </strong>I was repeatedly reassured that the lab's manual flagging system for leukocytosis was the key in reaching the correct diagnosis. My persistent inquiries, however, revealed that the flagging system was not functioning in the care of this patient. It was clinicians' suspicion of pseudohyperkalema that led to the correct diagnosis, although the clinicians' recommendation of obtaining a heparinized plasma for test did not play a role because all blood samples were already heparinized. The cause of pseudohyperkalemia was pneumatic tube transport. After this incident, our laboratory is investigating the options of using the Laboratory Information System to automatically flag the results and Clinical Laboratory Scientists to make the chemistry team more aware of potentially erroneous potassium results due to pseudohyperkalemia.</p><p><strong>Conclusions: </strong>Pseudohyperkalemia associated with leukocytosis still occurs. This is the first case of pneumatic tube transport causing pseudohyperkalemia associated with AML. When significant leukocytosis, thrombocytosis, hyperproteinemia, or hyperlipidemia is present, whole blood should be utilized for potassium measurements and walked to the lab instead of sent by pneumatic tube transport. Even in a lab with a manual flagging system, there is still room to improve by implementing an automatic flagging system.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"149"},"PeriodicalIF":2.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of cost-effectiveness of treating out of hospital cardiac arrest and the implications for resource-limited health systems.","authors":"Kalin Werner, Sarah Hirner, O Agatha Offorjebe, Edouard Hosten, Julian Gordon, Heike Geduld, Lee A Wallis, Nicholas Risko","doi":"10.1186/s12245-024-00727-w","DOIUrl":"10.1186/s12245-024-00727-w","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) is a prevalent condition with high mortality and poor outcomes even in settings where extensive emergency care resources are available. Interventions to address OHCA have had limited success, with survival rates below 10% in national samples of high-income countries. In resource-limited settings, where scarcity requires careful priority setting, more data is needed to determine the optimal allocation of resources.</p><p><strong>Objective: </strong>To establish the cost-effectiveness of OHCA care and assess the affordability of interventions across income settings.</p><p><strong>Methods: </strong>The authors conducted a systematic review of economic evaluations on interventions to address OHCA. Six databases (PubMed, EMBASE, Global Health, Cochrane, Global Index Medicus, and Tuft's Cost-Effectiveness Registry) were searched in September 2023. Included studies were (1) economic evaluations (beyond a simple costing exercise); and (2) assessed an intervention in the chain of survival for OHCA. Article quality was assessed using the CHEERs checklist and data summarised. Findings were reported by major themes identified by the reviewers. Based upon the results of the cost-effectiveness analyses we then conduct an analysis for the progressive realization of the OHCA chain of survival from the perspective of decision-makers facing resource constraints.</p><p><strong>Results: </strong>Four hundred and sixty-eight unique articles were screened, and 46 articles were included for final data abstraction. Studies predominantly used a healthcare sector perspective, modeled for all patients experiencing non-traumatic cardiac OHCA, were based in the US, and presented results in US Dollars. No studies reported results or used model inputs from low-income settings. Progressive realization of the chain of survival could likely begin with investments in termination of resuscitation protocols, professional prehospital defibrillator use, and CPR training followed by the distribution of AEDs in high-density public locations. Finally, other interventions such as indiscriminate defibrillator placement or adrenaline use, would be the lowest priority for early investment.</p><p><strong>Conclusion: </strong>Our review found no high-quality evidence on the cost-effectiveness of treating OHCA in low-resource settings. Existing evidence can be utilized to develop a roadmap for the development of a cost-effective approach to OHCA care, however further economic evaluations using context-specific data are crucial to accurately inform prioritization of scarce resources within emergency care in these settings.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":"17 1","pages":"151"},"PeriodicalIF":2.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}