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Prehospital advanced cardiac life support with a smartphone-based direct medical oversight in a metropolitan city: a before-after population-based study
Med Biol Sci Eng 2021;4(1):1-9
Published online January 31, 2021
© 2021 Medical Biological Science and Engineering.

Jae Jin Hong, Seong Jung Kim, Yongjin Park

Department of Emergency Medicine, School of Medicine, Chosun University, Gwangju, Korea
Correspondence to: Yongjin Park
Department of Emergency Medicine, School of Medicine, Chosun University, 365 Pilmundaero, Dong-gu, Gwangju 61452, Korea
Tel: +82-62-220-3285
Fax: +82-62-224-3501
Received October 16, 2020; Revised October 21, 2020; Accepted October 26, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
This study aimed to determine whether advanced life support (ALS) under emergency physician’s direct medical oversight through video call on smartphones was associated with improved out-of-hospital cardiac arrest (OHCA) outcomes on “Smart Advanced Life Support (SALS)” pilot project. This study was conducted with a “before-after” controlled trial. We divided the OHCA patients in a metropolitan city with a population of 1.5 million into two periods. The ‘Before’ phase was performed the basic life support (BLS group) in 2014, and the ‘after’ phase was performed the ALS using video calls on smartphones (SALS group) in 2015. The primary and secondary outcomes were survival to discharge and a good neurological outcome, respectively. We conducted propensity score matching to equalize potential prognostic factors in both groups. 235 OHCA patients were enrolled in the BLS group, 198 patients in the SALS group. The outcomes were better in the SALS group than in the BLS group for survival to discharge and good neurological outcome, respectively. The adjusted ORs of SALS group compared to those BLS group 1.33 (95% CI 1.00-1.77) for survival to discharge and 1.73 (95% CI 1.19-2.53) for good neurologic outcome. An emergency medical system intervention using the SALS protocol was associated with a significant increase in prehospital ROSC and an improved survival and neurologic outcome after OHCA.
Keywords : Out-of-hospital cardiac arrest; Smartphone; Advanced cardiac life support; Emergency medical system
  1. But given the procedure in Korea for OHCA, only basic life support (BLS) is given at the site within 5 minutes and then transported to the hospital so it is difficult to expect circulation recovery before arriving at a hospital. A number of the study support that prehospital advanced life support (ALS) was not effective for out-of-hospital cardiac arrest (OHCA) patients [5-9]. The experience of the paramedics exposed to OHCA patients affects the treatment of cardiac arrest, but the actual exposure of the paramedics is rare and declining. Prehospital emergency medical direction (EMS) - physician presence was associated with improved survival outcomes of the patient, but the characteristics of the EMS operating in each country are different, and there are places where the operation is not possible in reality [1012]. However, recently developed video communication technologies have created opportunities to make various attempts in the medical field. A “Smart Advanced Life Support” (SALS) pilot project was introduced to some areas on a trial basis; where in the event of a cardiac arrest, the nearest two units of emergency medical services (EMS) are dispatched, and through the visual directions of an emergency physician, the paramedics will use the manual defibrillator, administer drugs, and perform advanced life support. The objective of this study was to determine whether SALS under physician’s direct medical oversight through video call on smartphones was associated with improved OHCA outcomes in a metropolitan city.
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July 2022, 5 (2)
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