Abstract 249: The Effect of Response Time on Out-Of-Hospital Cardiac Arrest Survival Varies by Patient Subpopulation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Clara Stoesser ◽  
Justin Boutilier ◽  
Christopher L Sun ◽  
Katie N Dainty ◽  
Steve Lin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Regression Analysis ◽  
Response Time ◽  
Time Interval ◽  
Probability Of Survival ◽  
Subgroup Analyses ◽  
Impact On Survival ◽  
The Impact ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Itroduction: Previous research has quantified the impact of EMS response time on the probability of survival from OHCA, but the impact on different subpopulations is currently unknown. Aim: To investigate how response time affects OHCA survival for different patient subpopulations. Methods: We conducted a logistic regression analysis on non-EMS witnessed OHCAs of presumed cardiac etiology from the Toronto Regional RescuNet between January 1, 2007 and December 31, 2016. We predicted survival using age, sex, public location, presenting rhythm, bystander witnessed, bystander resuscitation, and response time, defined as the time interval from 911 call to EMS arrival at the patient. We conducted subgroup analyses to quantify the effect of response time on survival for eight different subpopulations: public, private, bystander resuscitation, no bystander resuscitation, patients ≥65, patients <65, witnessed, and unwitnessed OHCA. We also quantified the effect of response time on survival for pairwise intersections of the subpopulations. We compared our results to Valenzuela et al. (1997), which suggests survival odds decrease by 10% for each minute delay in response time. Results: We identified 22,988 OHCAs. Overall, a one-minute delay in EMS response time was associated with a 13.2% reduction in the odds of survival. The reduction varied by subpopulation, ranging from a 7.2% reduction in survival odds for unwitnessed arrests to a 16.4% reduction in survival odds for arrests with bystander resuscitation. Response time had the largest impact on survival for the subpopulation of OHCAs that were both witnessed and received bystander resuscitation (17.4% reduction in survival odds). Conclusion: The effect of a one-minute delay in EMS response on the odds of survival from OHCA can be as low as a 7.2% reduction and as high as a 17.4% reduction. This variability contrasts with the currently accepted 10% rule that is assumed across the entire population.

scholarly journals Measuring the impact of emergency medical services (EMS) on out-of-hospital cardiac arrest survival in a developing country

Medicine ◽  
2017 ◽  
Vol 96 (29) ◽  
pp. e7570 ◽  
Author(s):  
Mazen El Sayed ◽  
Reem Al Assad ◽  
Yasmin Abi Aad ◽  
Nour Gharios ◽  
Marwan M. Refaat ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Emergency Medical Services ◽  
Developing Country ◽  
Medical Services ◽  
Emergency Medical ◽  
The Impact ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

scholarly journals Response Time Threshold for Predicting Outcomes of Patients with Out-of-Hospital Cardiac Arrest

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ling Hsuan Huang ◽  
Yu-Ni Ho ◽  
Ming-Ta Tsai ◽  
Wei-Ting Wu ◽  
Fu-Jen Cheng
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Hospital Discharge ◽  
Youden Index ◽  
Roc Curve Analysis ◽  
Optimal Response ◽  
Time Threshold ◽  
Bystander Cpr ◽  
The Impact ◽  
Hospital Cardiac Arrest

Ambulance response time is a prognostic factor for out-of-hospital cardiac arrest (OHCA), but the impact of ambulance response time under different situations remains unclear. We evaluated the threshold of ambulance response time for predicting survival to hospital discharge for patients with OHCA. A retrospective observational analysis was conducted using the emergency medical service (EMS) database (January 2015 to December 2019). Prehospital factors, underlying diseases, and OHCA outcomes were assessed. Receiver operating characteristic (ROC) curve analysis with Youden Index was performed to calculate optimal cut-off values for ambulance response time that predicted survival to hospital discharge. In all, 6742 cases of adult OHCA were analyzed. After adjustment for confounding factors, age (odds ratio [OR] = 0.983, 95% confidence interval [CI]: 0.975–0.992, p < 0.001 ), witness (OR = 3.022, 95% CI: 2.014–4.534, p < 0.001 ), public location (OR = 2.797, 95% CI: 2.062–3.793, p < 0.001 ), bystander cardiopulmonary resuscitation (CPR, OR = 1.363, 95% CI: 1.009–1.841, p = 0.044 ), EMT-paramedic response (EMT-P, OR = 1.713, 95% CI: 1.282–2.290, p < 0.001 ), and prehospital defibrillation using an automated external defibrillator ([AED] OR = 3.984, 95% CI: 2.920–5.435, p < 0.001 ) were statistically and significantly associated with survival to hospital discharge. The cut-off value was 6.2 min. If the location of OHCA was a public place or bystander CPR was provided, the threshold was prolonged to 7.2 min and 6.3 min, respectively. In the absence of a witness, EMT-P, or AED, the threshold was reduced to 4.2, 5, and 5 min, respectively. The adjusted OR of EMS response time for survival to hospital discharge was 1.217 (per minute shorter, CI: 1.140–1299, p < 0.001 ) and 1.992 (<6.2 min, 95% CI: 1.496–2.653, p < 0.001 ). The optimal response time threshold for survival to hospital discharge was 6.2 min. In the case of OHCA in public areas or with bystander CPR, the threshold was prolonged, and without witness, the optimal response time threshold was shortened.

Association of response time interval with neurological outcomes after out-of-hospital cardiac arrest according to bystander CPR

2020 ◽  
Vol 38 (9) ◽  
pp. 1760-1766
Author(s):  
Sungbae Moon ◽  
Hyun Wook Ryoo ◽  
Jae Yun Ahn ◽  
Dong Eun Lee ◽  
Sang Do Shin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Time Interval ◽  
Neurological Outcomes ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

scholarly journals The prognostic significance of repeated prehospital shocks for out-of-hospital cardiac arrest survival

CJEM ◽  
2018 ◽  
Vol 21 (3) ◽  
pp. 330-338 ◽  
Author(s):  
Alexis Cournoyer ◽  
Éric Notebaert ◽  
Sylvie Cossette ◽  
Luc Londei-Leduc ◽  
Luc de Montigny ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Hospital Discharge ◽  
Prognostic Significance ◽  
Probability Of Survival ◽  
Shockable Rhythm ◽  
Malignant Arrhythmia ◽  
The Relationship ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

ABSTRACTObjectivesPatients suffering from an out-of-hospital cardiac arrest (OHCA) associated with an initial shockable rhythm have a better prognosis than their counterparts. The implications of recurrent or refractory malignant arrhythmia in such context remain unclear. The objective of this study is to evaluate the association between the number of prehospital shocks delivered and survival to hospital discharge among patients in OHCA.MethodsThis cohort study included adult patients with an initial shockable rhythm over a 5-year period from a registry of OHCA in Montreal, Canada. The relationship between the number of prehospital shocks delivered and survival to discharge was described using dynamic probabilities. The association between the number of prehospital shocks delivered and survival to discharge was assessed using multivariable logistic regression.ResultsA total of 1,788 patients (78% male with a mean age of 64 years) were included in this analysis, of whom 536 (30%) received treatments from an advanced care paramedic. A third of the cohort (583 patients, 33%) survived to hospital discharge. The probability of survival was highest with the first shock (33% [95% confidence interval 30%-35%]), but decreased to 8% (95% confidence interval 4%-13%) following nine shocks. A higher number of prehospital shocks was independently associated with lower odds of survival (adjusted odds ratio=0.88 [95% confidence interval 0.85-0.92], p < 0.001).ConclusionSurvival remains possible even after a high number of shocks for patients suffering from an OHCA with an initial shockable rhythm. However, requiring more shocks is independently associated with worse survival.

scholarly journals Association Between Modifiable Prehospital Prognostic Factors on Out-Of-Hospital Cardiac Arrest in Different Age Groups

2020 ◽  
Author(s):  
Jyun-Bin Huang ◽  
Kuo-Hsin Lee ◽  
Yu-Ni Ho ◽  
Ming-Ta Tsai ◽  
Wei-Ting Wu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Prognostic Factors ◽  
Response Time ◽  
Age Groups ◽  
Kaplan Meier ◽  
Bystander Cpr ◽  
Underlying Diseases ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
External Defibrillator

Abstract Background The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor. While several prehospital factors are known to be associated with improved survival, the impact of prehospital factors on different age groups is unclear. The objective of the study was to access the impact of prehospital factors and pre-existing comorbidities on OHCA outcomes in different age groupsMethods A retrospective observational analysis was conducted using the emergency medical service (EMS) database from January 2015 to December 2019. We collected information on prehospital factors, underlying diseases, and outcome of OHCAs in different age groups. Kaplan-Meier type survival curves and multivariable logistic regression were used to analyze the association between modifiable pre-hospital factors and outcomes. Results A total of 4188 witnessed adult OHCAs were analyzed. For the younger group (age ≦75 years old), after adjustment for confounding factors, EMS response time (odds ratio [OR]=0.860, 95% confidence interval [CI]: 0.811-0.909, p<0.001), public location (OR=1.843, 95% CI: 1.179-1.761, p<0.001), bystander CPR (OR=1.329, 95% CI: 1.007-1.750, p=0.045), attendance by an EMT-Paramedic (OR=1.666, 95% CI: 1.277-2.168, p<0.001), and prehospital defibrillation by automated external defibrillator (AED)(OR=1.666, 95% CI: 1.277-2.168, p<0.001) were prognostic factors for OHCA. For the older group (age >75 years old), age (OR=0.924, CI: 0.880-0.966, p=0.001), EMS response time (OR=0.833, 95% CI: 0.742-0.928, p=0.001), public location (OR=4.290, 95% CI: 2.450-7.343, p<0.001), and attendance by an EMT-Paramedic (OR=2.702, 95% CI: 1.704-4.279, p<0.001) were independent prognostic factors for OHCA.Conclusions There were variations between younger and older OHCA patients. We found that bystander CPR and prehospital defibrillation by AED were independent prognostic factors for younger OHCA patients but not for the older group.

scholarly journals Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jyun-Bin Huang ◽  
Kuo-Hsin Lee ◽  
Yu-Ni Ho ◽  
Ming-Ta Tsai ◽  
Wei-Ting Wu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Prognostic Factors ◽  
Response Time ◽  
Hospital Discharge ◽  
Age Groups ◽  
Age Group ◽  
Bystander Cpr ◽  
Group 2 ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor. While several prehospital factors are known to be associated with improved survival, the impact of prehospital factors on different age groups is unclear. The objective of the study was to access the impact of prehospital factors and pre-existing comorbidities on OHCA outcomes in different age groups. Methods A retrospective observational analysis was conducted using the emergency medical service (EMS) database from January 2015 to December 2019. We collected information on prehospital factors, underlying diseases, and outcome of OHCAs in different age groups. Kaplan-Meier type survival curves and multivariable logistic regression were used to analyze the association between modifiable pre-hospital factors and outcomes. Results A total of 4188 witnessed adult OHCAs were analyzed. For the age group 1 (age ≦75 years old), after adjustment for confounding factors, EMS response time (odds ratio [OR] = 0.860, 95% confidence interval [CI]: 0.811–0.909, p < 0.001), public location (OR = 1.843, 95% CI: 1.179–1.761, p < 0.001), bystander CPR (OR = 1.329, 95% CI: 1.007–1.750, p = 0.045), attendance by an EMT-Paramedic (OR = 1.666, 95% CI: 1.277–2.168, p < 0.001), and prehospital defibrillation by automated external defibrillator (AED)(OR = 1.666, 95% CI: 1.277–2.168, p < 0.001) were prognostic factors for survival to hospital discharge in OHCA patients. For the age group 2 (age > 75 years old), age (OR = 0.924, CI:0.880–0.966, p = 0.001), EMS response time (OR = 0.833, 95% CI: 0.742–0.928, p = 0.001), public location (OR = 4.290, 95% CI: 2.450–7.343, p < 0.001), and attendance by an EMT-Paramedic (OR = 2.702, 95% CI: 1.704–4.279, p < 0.001) were independent prognostic factors for survival to hospital discharge in OHCA patients. Conclusions There were variations between younger and older OHCA patients. We found that bystander CPR and prehospital defibrillation by AED were independent prognostic factors for younger OHCA patients but not for the older group.

scholarly journals Impact of epinephrine administration frequency in out-of-hospital cardiac arrest patients: a retrospective analysis in a tertiary hospital setting

2019 ◽  
Vol 47 (9) ◽  
pp. 4272-4283
Author(s):  
Mohammed A. Al-Mulhim ◽  
Mohammed S. Alshahrani ◽  
Laila Perlas Asonto ◽  
Ahmad Abdulhady ◽  
Talal M. Almutairi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Retrospective Analysis ◽  
Patient Survival ◽  
Time Interval ◽  
Ohca Patient ◽  
Epinephrine Administration ◽  
Significant Difference ◽  
Epinephrine Dose ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction Epinephrine is recommended for patients with out-of-hospital cardiac arrest (OHCA). However, whether epinephrine improves or adversely affects OHCA outcomes is controversial. Objectives This study aims to determine whether the frequency of epinephrine administration impacts OHCA patient survival. Methods We conducted a retrospective analysis of OHCA cases registered in the Emergency Department at King Fahd University Hospital, Saudi Arabia between 2005 and 2015. The primary outcomes were mortality and survival rates until discharge. The impact of epinephrine administration timing and frequency on patient survival was analyzed. Results Data from 300 OHCA cases were analyzed. Among them, 66.3% were men, and the overall mean age of 50.4 ± 20.6 years. The overall survival rate until hospital discharge was 12%. There was no statistically significant difference between in gender, age, or time interval to the first epinephrine dose in the survival and non-survival groups. Only the number of epinephrine doses was related to the survival outcome. Conclusion Non-survivors received significantly more epinephrine doses compared with survivors. However, a causal relationship between OHCA patient survival and epinephrine dose and time cannot be confirmed. Further studies are needed to investigate whether the long-term outcomes in OHCA patients are influenced by the timing and frequency of epinephrine administration.

Abstract 10611: Variation in Out-of-Hospital Cardiac Arrest Survival Across EMS Agencies

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
R Garcia ◽  
Bryan McNally ◽  
Saket Girotra ◽  
Paul S Chan ◽  
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Hospital Admission ◽  
Geographic Region ◽  
Hierarchical Logistic Regression ◽  
Initial Rhythm ◽  
The Mean ◽  
Adjusted Rate ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest

Background: Although some studies have reported variation in out-of-hospital cardiac arrest (OHCA) survival by neighborhood and geographic region, little is known about variation in OHCA survival at the level of EMS agencies—which, unlike neighborhoods and regions, may have modifiable resuscitation practices. Methods: Within the national Cardiac Arrest Registry to Enhance Survival, we identified 258,320 non-traumatic OHCAs from 764 EMS agencies with ≥10 OHCAs annually between 2015-2019. Using multivariable hierarchical logistic regression, we computed risk-adjusted rates of survival to hospital admission for each EMS agency. We quantified the extent of variation in survival with the median odds ratios (MOR) and assessed the extent to which variation in survival was explained by two EMS agency resuscitation practices: time from 911 call to EMS arrival and the proportion of OHCAs at each EMS agency with termination of resuscitation (TOR) without meeting TOR futility criteria. Results: Of 258,320 persons with OHCA, mean age was 62.2 ± 17.0 years and 36.1% were female. Overall, 85.0% were of presumed cardiac etiology, 82.3% occurred at home, 44.0% were witnessed by a bystander, and ~75% were due to a non-shockable initial rhythm. Across the 764 EMS agencies, the median risk-adjusted rate of survival to hospital admission was 27.4% (IQR, 24.5% - 30.2%). The adjusted MOR was 1.35 (95% CI: 1.32, 1.39), suggesting that the odds of survival to hospital admission after an OHCA varied by 35% in two identical patients in one randomly selected EMS agency vs. another. EMS agencies in the lowest quartile of risk-adjusted survival had a mean EMS response time of 12.0 ± 3.4 minutes, whereas those in the highest quartile had a mean EMS response time of 9.0 ± 2.6 minutes ( P <0.001). The mean proportion of OHCA cases where CPR was terminated in the field without meeting TOR futility criteria was 27.9% ±16.1% in quartile 1 and 18.9% ±11.4% in quartile 4 ( P <0.001). Adjustment for the EMS-level variation in both resuscitation practices attenuated the MOR to 1.30 (95% CI: 1.27, 1.33). Conclusions: Rates of survival to hospital admission for OHCA vary significantly by EMS agency, and some of this variation in survival is explained by differences in EMS arrival time and TOR practice patterns.

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