This cross-sectional study was conducted using a prospectively collected nationwide emergency medical service (EMS)-based OHCA registry from Korea. This study was approved by the Institutional Review Board (IRB) of the study institution (IRB No. 1103-153-357). The requirement for informed consent was waived.
The National Fire Agency operates a prehospital EMS system exclusively in Korea. In cases of OHCA, all EMS providers can provide basic life support, and qualified EMS providers can provide advanced life support, including advanced airway management, intravenous catheter insertion, or epinephrine use under direct medical control. EMS providers have no authority to declare death or stop CPR unless there is ROSC, and all OHCA patients should be transported to the hospital. There is no prehospital ECMO programme in Korea; therefore, all ECPR procedures can be performed in a hospital.
The Korean Ministry of Health has designated the following three levels of emergency department (ED): level 1 (n = 36) and level 2 (n = 119), which provide the highest level of emergency care services with emergency physicians on staff all times, and level 3 (n = 261), which may be staffed by general physicians. All EDs generally perform acute cardiac care and post-resuscitation care in accordance with national guidelines national guidelines that were adapted from the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care [18 (link), 19 (link)]. No major differences in post-resuscitation care recommendations were observed between the two guidelines. In 2020, 74 EDs conducted at least one extracorporeal life support (ECLS) intervention for OHCA patients (median [interquartile range] volume of ECLS for OHCA 4 (2–6). The decision to perform ECPR is determined by attending physicians at each centre, and eligibility criteria using age, comorbidities, and cardiac rhythm can be used according to the centre [20 (link)–22 (link)]. In most centres, ECPR is performed by thoracic surgeons or cardiologists rather than an emergency physician.
The National Fire Agency operates a prehospital EMS system exclusively in Korea. In cases of OHCA, all EMS providers can provide basic life support, and qualified EMS providers can provide advanced life support, including advanced airway management, intravenous catheter insertion, or epinephrine use under direct medical control. EMS providers have no authority to declare death or stop CPR unless there is ROSC, and all OHCA patients should be transported to the hospital. There is no prehospital ECMO programme in Korea; therefore, all ECPR procedures can be performed in a hospital.
The Korean Ministry of Health has designated the following three levels of emergency department (ED): level 1 (n = 36) and level 2 (n = 119), which provide the highest level of emergency care services with emergency physicians on staff all times, and level 3 (n = 261), which may be staffed by general physicians. All EDs generally perform acute cardiac care and post-resuscitation care in accordance with national guidelines national guidelines that were adapted from the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care [18 (link), 19 (link)]. No major differences in post-resuscitation care recommendations were observed between the two guidelines. In 2020, 74 EDs conducted at least one extracorporeal life support (ECLS) intervention for OHCA patients (median [interquartile range] volume of ECLS for OHCA 4 (2–6). The decision to perform ECPR is determined by attending physicians at each centre, and eligibility criteria using age, comorbidities, and cardiac rhythm can be used according to the centre [20 (link)–22 (link)]. In most centres, ECPR is performed by thoracic surgeons or cardiologists rather than an emergency physician.
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