Optimizing Data-Driven Strategies for Enhancing Survival Outcomes in Out-of-Hospital Cardiac Arrest (OHCA) Patients in Thailand
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Dissertation Synopsis: Part 1: Out-of-hospital cardiac arrest (OHCA) remains a significant public health concern in Thailand, with early intervention being critical for improving survival outcomes. However, variations in pre-hospital care may influence these outcomes across different healthcare settings. This study analyzed adult OHCA cases between 2017 and 2023 using data collected through the Pan-Asian Resuscitation Outcomes Study (PAROS) form at three study sites representing regional, suburban, and urban contexts. Descriptive statistics and multivariable logistic regression were used to explore factors associated with patient survival upon hospital arrival. Among 2,255 eligible cases, three main factors were significantly associated with survival: the location where the arrest occurred, the provision of bystander CPR, and EMS response time. All three factors showed notable differences between urban and provincial settings, as well as across pre- and post-COVID periods. These findings emphasize the need for robust, long-term data collection across the country to better understand survival determinants and guide national strategies. There is also a critical need for improved data infrastructure and user-friendly technology to streamline reporting and accuracy. Finally, future efforts should include follow-up of OHCA patients throughout their hospital stay to assess longer-term outcomes and determine the true impact of pre-hospital interventions. Part 2: Regardless of income level, cardiovascular disease (CVD) is the leading cause of death worldwide – with out-of-hospital cardiac arrest (OHCA) being a major contributor. Despite its impact, Thailand lacks a standardized national OHCA data collection system, making it difficult to measure and improve outcomes. This mixed-methods study utilizes data from three participating hospitals using the Pan-Asian Resuscitation Outcomes Study (PAROS) tool, along with in-depth interviews with 20 key stakeholders, to identify systemic challenges and highlight the critical need for comprehensive OHCA surveillance. By integrating both quantitative data and qualitative insights, we examine key obstacles, including an already overburdened healthcare system, a fragmented emergency response structure involving multiple agencies with varying oversight, and limited public awareness of available emergency services and bystander interventions. Our findings aim to inform policymakers of the urgent need for a nationwide OHCA registry, increased funding, and coordinated efforts to enhance data collection and improve survival rates in Thailand.
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