This South Korean retrospective cohort included 129,207 adult out-of-hospital cardiac arrests and compared regional changes after implementation of video-assisted physician-directed advanced life support using difference-in-differences analyses. Compared with nonimplementing regions, implementing regions had a greater increase in prehospital ROSC: 1.35 percentage points (95% CI, 0.56 to 2.15). There were no significant additional improvements in survival to discharge (−0.35 percentage points; 95% CI, −1.31 to 0.62) or favorable neurological outcome (−0.35 percentage points; 95% CI, −1.08 to 0.37). Prehospital time increased by an additional 4.12 minutes (95% CI, 2.91 to 5.33).
Regional implementation was associated with increased prehospital ROSC, but no demonstrated improvement in discharge survival or favorable neurological outcome. These observational findings do not establish a causal benefit.
Study limitation: The observational design limits causal inference, and differential pre-intervention trends specifically weaken interpretation of the prehospital time finding.
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