Regional disparities and temporal trends in pre-hospital management of out-of-hospital cardiac arrest in Thailand: a multi-center retrospective cohort study (2017–2023)

Abstract

Background Out-of-hospital cardiac arrest remains a major public health concern in Thailand, where pre-hospital care and survival outcomes vary widely across regions. Furthermore, national-level data remains sparse and fragmented. Methods This retrospective, multicenter cohort study analyzed adult out-of-hospital cardiac arrest cases from 2017 to 2023 using standardized data from the Pan-Asian Resuscitation Outcomes Study registry. Patients were included if they received emergency medical services in the field, regardless of whether they were transported to hospital or not. The study involved three hospitals representing regional, suburban-capital, and urban-capital settings. The primary outcome was 30-day survival. A modified Poisson regression with robust error variance was performed to identify pre-hospital factors associated with survival. Results Among 2259 eligible cases, 30-day survival was low, with notable variation across hospital settings. Bystander cardiopulmonary resuscitation was most frequent in the suburban-capital hospital (47.2%) and lowest in the regional hospital (23.7%). Family members were the most common providers of bystander cardiopulmonary resuscitation across all sites, though healthcare professionals were more frequently involved in the regional hospital. Multivariable analysis showed that bystander cardiopulmonary resuscitation and shorter emergency medical services response time were significantly associated with improved survival, while advanced airway management and transport time were not. Conclusion This study confirmed the importance of bystander cardiopulmonary resuscitation and services response time in patient survival in Thailand and highlighted regional disparities. A coordinated national registry is urgently needed for targeted improvements. Lack of standardized and comprehensive data, especially neurologic outcomes and long-term survival, hinders performance evaluation and evidence-based reform.