Abstract 9086: Sex Differences in the Association Between Bystander CPR and Survival for Patients With Out-of-Hospital Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Kiok Ahn ◽  
Bryan McNally ◽  
Paul Chan
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Significant Interaction ◽  
National Registry ◽  
Republic Of Korea ◽  
Secondary Outcome ◽  
Multivariable Logistic Regression ◽  
Bystander Cpr ◽  
The Republic ◽  
Hospital Cardiac Arrest

Background: Bystander cardiopulmonary resuscitation (CPR) is associated with a better survival outcome in patients with out-of-hospital cardiac arrest (OHCA). However, there may be cultural barriers in performing high-quality bystander CPR in women in some non-Western countries and the effect of bystander CPR on survival outcomes may differ by patients’ sex. Methods: Using data between 2012-2018 from a national OHCA registry from the Republic of Korea, we identified adult patients with OHCA of presumed cardiac etiology. The main exposures were bystander CPR and patients’ sex. The primary outcome was survival discharge and the secondary outcome was favorable neurological survival. Multivariable logistic regression evaluated the association between bystander CPR and survival, adjusted for patients’ age, sex, socio-economic status, year of arrest, witnessed arrest status, initial OHCA rhythm, location of arrest, urbanization level of arrest location, and type of bystander. The interaction between bystander CPR and sex was explicitly evaluated in the models. Results: Of 101,505 patients with OHCA in the cohort, 34,124 (33.6 %) were women and 67,381 (64.4 %) were men. Bystander CPR was performed on 18,481 (54.2%) women and 35,904 (53.3%) men (p=0.07). Unadjusted rates of survival discharge were 4.5% in women and 9.5 % in men (p<0.001), and rates of favorable neurological survival were 2.5% in women and 6.4% in men (p<0.001). In multivariable logistic regression models, there was a significant interaction (p=0.005) between bystander CPR and sex for survival to discharge, with an adjusted OR for bystander CPR of 1.16 (95% CI: 1.08-1.23) in men and 0.91 (95% CI: 0.80-1.02) in women. For favorable neurological survival, there was also a significant interaction (p=0.01) between sex and bystander CPR, with an adjusted OR for bystander CPR of 1.47 (95% CI: 1.36-1.60) in men and 1.16 (95% CI: 0.98- 1.37) in women. Conclusions: In a national registry of OHCA from the Republic of Korea, men who received bystander CPR were more likely to survive whereas women who received bystander CPR were not.

Abstract P80: Short-term Outcomes of Vasopressin Administerd with Epinephrine versus Epinephrine Alone in ED for Out-of-hospital Cardiac Arrest

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tae Yun Kim ◽  
Sun Woo Lee ◽  
Kyuseok Kim ◽  
Joong Eui Rhee ◽  
Sung Koo Jung
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
National Registry ◽  
Controlled Clinical Trial ◽  
Emergency Medical Service System ◽  
Short Term ◽  
Combined Administration ◽  
Before And After ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OOHCA) victims are increasing, but emergency medical service system (EMSS) is not ready for them in Korea. A previous randomized, controlled clinical trial has suggested that vasopressin followed epinephrine was superior to epinephrine in patients with asystole. According to the Korean national registry of OOHCA, patients with asystole were more than two thirds of them. In Korean EMSS, no drugs are permitted to administer in the prehospital phase by law. Thereafter epinephrine or vasopressin cannot be administered until patients are transported to emergency departments (EDs). This study was to evaluate whether the combined administration of vasopressin and epinephrine in ED for OOHCA patients would increase the return of spontaneous circulation (ROSC) and survival discharge. Methods: From October 2007 to May 2008, we changed the CPR protocol in adult, nontraumatic OOHCA that 40 U of vasopressin was administered as soon as possible after the first dose of epinephrine (the after group). Cardiac arrest data were collected using the Utstein template. Data from January to September 2007, when vasopressin has not been used, were also collected for comparative analysis (the before group). These two groups were compared in terms of ROSC, and survival discharge Results: There were 45 and 50 patients in the before and after groups, respectively. There was no significant differences in the initial ECG rhythm of asystole (67% vs 78%), witnessed arrest (73% vs 72%), bystander CPR (16% vs 10%), time from collapse to BLS time (6 min vs 8.5 min), and time from collapse to study drugs (23 min vs 26.5 min). The rate of sustained ROSC was similar between the before and after groups (53% vs 48%, P=0.604) as was the survival discharge (27% vs 14%, P=0.123). Conclusions: Vasopressin with administerd with epinephrine does not increase the rate of ROSC nor the survival discharge.

Abstract 19427: Epidemiology and Outcomes of Out-of-hospital Cardiac Arrest in Qatar

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Furqan B Irfan ◽  
Zain A Bhutta ◽  
Tooba Tariq ◽  
Loua A Shaikh ◽  
Pregalathan Govender ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Incidence Rate ◽  
Hospital Discharge ◽  
Middle Eastern ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Final Analysis ◽  
National Registry ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Aim: There is a scarcity of population based studies on out-of-hospital cardiac arrest (OHCA) in the Middle East and the wider Asian region. This study describes the Epidemiology and outcomes of OHCA in Qatar, a Middle Eastern country. Methods: Data was extracted retrospectively from a national registry on all adult cardiac origin OHCA patients attended by Emergency Medical Services (EMS) in Qatar, from June 2012 - May 2013. Results: The annual crude incidence rate of cardiac origin OHCA attended by EMS was 23.5 per 100,000. The age-sex standardized incidence rate was 87.83 per 100,000 population. The annual sex-standardized incidence rate for males and females was 91.5 and 84.25 per 100,000 population respectively. Of 447 adult, cardiac origin OHCA patients included in the final analysis, most were male (n=360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities of OHCA cases were Qatari (n=89, 19.9%), Indian (n=74, 16.6%) and Nepalese (n=52, 11.6%). Common initial cardiac arrest rhythms were asystole (n=301, 67.3%), ventricular fibrillation (n=82, 18.3%) and pulseless electrical activity (n=49, 11%). OHCA was unwitnessed (n=220, 49%) in nearly half of the cases while bystanders witnessed it in 170 (38%) patients. Bystander CPR was carried out in 92 (20.6%) of the cases. Of 187 (41.8%) patients who were given shocks, bystander defibrillation was delivered to 12 (2.7%) patients. Prehospital outcomes; 332 (74.3%) patients did not achieve return of spontaneous circulation (ROSC), 40 (8.9%) patients achieved unsustainable ROSC, 58 (13%) achieved ROSC till Emergency department (ED) handover and 5 patients achieved ROSC but rearrested again before reaching ED. Survival to hospital discharge occurred in 38 (8.5%) patients. Neurological outcomes were assessed utilizing Cerebral Performance Category [CPC] scores with a favorable CPC score of 1-2 at discharge in 27 (6%) patients, while 11 (2.5%) patients had a poor CPC score of 3-4. Of those with CPC score 1-2 at hospital discharge, 59% and 26% had CPC score 1-2, at 1 and 3 years follow-up respectively. Overall survival was 9.7%. Conclusion: Standardized rates are comparable to western countries, there are significant opportunities to improve outcomes, including better bystander CPR.

scholarly journals Analysis of characteristics and trends of the In-Hospital Cardiac Arrest incidence in the Republic of Korea: clinical usefulness of national health insurance claim data

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Circulatory System ◽  
Claim Data ◽  
Republic Of Korea ◽  
Classification Of Diseases ◽  
The Republic ◽  
Hospital Cardiac Arrest

Backgrounds: In-Hospital Cardiac Arrest (IHCA) requires the preparation of considerable medical resources in hospitals. Furthermore, compared to Out-of-Hospital Cardiac Arrest, until recently, there have not been many studies on the incidence, characteristics, and prognosis of IHCA. This study is to examine IHCA event rates among hospitalized patients in the Republic of Korea from 2011 to 2015. Methods: The incidence of IHCA in adults was extracted from claim data of the National Health Insurance Service from 2011 to 2015, and analyzed according to age, sex, the classification under the 7th revision of the Korean Standard Classification of Diseases (KCD-7), hospital types, and provinces. Results: From 2011 to 2015, the overall incidence of IHCA in Korea was founded to be 3.00 per 1,000 hospitalizations. The overall 5-year IHCA incidence was higher in male at 3.92 cases per 1,000 hospitalizations and at female 2.19 cases per 1,000 hospitalizations. Incidence due to cardiovascular disease increased year by year, whereas incidences due to respiratory, neurological and infectious disease were decreasing, and in the case of oncologic disease, there was no change. In particular, patients with diseases of the circulatory system had at least a two times higher incidence compared to those with other diseases. The IHCA incidence in general hospitals and tertiary hospitals was at least two-fold higher than the national overall and showed an increasing trend. The provinces that showed a higher IHCA incidence than the five-year national overall were Jeju Special Self-Governing Province, Gangwon Province, and Seoul. Conclusions: The results of this study can be used as important basic data to secure patient safety by reducing the occurrence of IHCA.

Abstract 457: Comparison of Effect of Audio-Instructed and Video-Instructed Dispatcher-Assisted Cardiopulmonary Resuscitation on Resuscitation Outcomes After Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Sun Young Lee ◽  
Kyoung Jun Song ◽  
Sang Do Shin ◽  
Ki Jeong Hong ◽  
Kim Jong Hwan ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Secondary Outcome ◽  
Multivariable Logistic Regression Analysis ◽  
Time Interval ◽  
Good Neurological Outcome ◽  
Video Group ◽  
Hospital Cardiac Arrest

Introduction: This study aimed to compare the effect of audio-instructed dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) and video-instructed DA-CPR on resuscitation outcome after out-of-hospital cardiac arrest (OHCA) in the real world. Methods: A cross-sectional study was conducted for resuscitation-attempted adult OHCAs of 2017 in Seoul, Korea. Seoul implemented video-instructed DA-CPR program in 2017. According to the protocol, when dispatcher detected OHCA, they checked two condition: 1) more than two bystanders were in the scene, 2) they could handle a video-call. If both conditions were met, dispatcher initiated the CPR instruction and called back a video-call to the caller for instructing CPR via video (video group). Unless, standard audio-instructed DA-CPR was provided (audio group). The primary outcome was survival to discharge. The secondary outcome was good neurological outcome at hospital discharge. The tertiary outcome was early instruction time interval (ITI, time from call to the initiation of CPR instruction≤ 90 seconds). The study outcomes were compared between audio and video group. A multivariable logistic regression analysis was performed and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated adjusting for potential confounders. Propensity score matching (PSM) method was used to increase comparability of two groups and same logistic regression model was analyzed for the PSM population. Results: A total of 1,720 eligible OHCA cases (1,489 in audio and 231 in video group) were evaluated. The median seconds of ITI was 136 seconds in audio group and 122 seconds in the video group (p=0.12). Survival to discharge was 8.9% in audio group and 14.3% in video group (p<0.01). Good neurological outcome was 5.8% in audio group and 10.4% in video group (p<0.01). Compared with audio group, the AORs (95% CIs) for survival to discharge, good neurological outcome and early ITI of the video group were 1.20 (0.74 to 1.94), 1.28 (0.73 to 2.26) and 1.00 (0.70 t0 1.43), respectively. PSM population showed similar results with original population. Conclusion: Compared with audio-instructed DA-CPR, video-instructed DA-CPR was not associated with survival improvement in the observational study.

scholarly journals Potential Candidates for a Structured Canadian ECPR Program for Out-of-Hospital Cardiac Arrest

CJEM ◽  
2016 ◽  
Vol 18 (6) ◽  
pp. 453-460 ◽  
Author(s):  
Brian Grunau ◽  
Frank Xavier Scheuermeyer ◽  
Dion Stub ◽  
Robert H. Boone ◽  
Joseph Finkler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Secondary Analysis ◽  
Secondary Outcome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
High Performing ◽  
Canadian Health ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest ◽  
Refractory Cardiac Arrest

AbstractObjectiveExtracorporeal cardiopulmonary resuscitation (ECPR), while resource-intensive, may improve outcomes in selected patients with refractory out-of-hospital cardiac arrest (OHCA). We sought to identify patients who fulfilled a set of ECPR criteria in order to estimate: (1) the proportion of patients with refractory cardiac arrest who may have benefited from ECPR; and (2) the outcomes achieved with conventional resuscitation.MethodsWe performed a secondary analysis from a 52-month prospective registry of consecutive adult non-traumatic OHCA cases from a single urban Canadian health region serving one million patients. We developed a hypothetical ECPR-eligible cohort including adult patients <60 years of age with a witnessed OHCA, and either bystander CPR or EMS arrival within five minutes. The primary outcome was the proportion of ECPR-eligible patients who had refractory cardiac arrest, defined as termination of resuscitation pre-hospital or in the ED. The secondary outcome was the proportion of EPCR-eligible patients who survived to hospital discharge.ResultsOf 1,644 EMS-treated OHCA, 168 (10.2%) fulfilled our ECPR criteria. Overall, 54/1644 (3.3%; 95% CI 2.4%-4.1%) who were ECPR-eligible had refractory cardiac arrest. Of ECPR-eligible patients, 114/168 (68%, 95% CI 61%-75%) survived to hospital admission, and 70/168 (42%; 95% CI 34-49%) survived to hospital discharge.ConclusionIn our region, approximately 10% of EMS-treated cases of OHCA fulfilled our ECPR criteria, and approximately one-third of these (an average of 12 patients per year) were refractory to conventional resuscitation. The integration of an ECPR program into an existing high-performing system of care may have a small but clinically important effect on patient outcomes.

Location of out-of-hospital cardiac arrest and the awareness time interval: a nationwide observational study

2021 ◽  
pp. emermed-2020-209903
Author(s):  
Seo Young Kim ◽  
Sun Young Lee ◽  
Tae Han Kim ◽  
Sang Do Shin ◽  
Kyoung Jun Song ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Observational Study ◽  
Secondary Outcome ◽  
Multivariable Logistic Regression Analysis ◽  
Time Interval ◽  
Nursing Facilities ◽  
Public Places ◽  
Bystander Cpr ◽  
Private Housing ◽  
Hospital Cardiac Arrest

AimsA short awareness time interval (ATI, time from witnessing the arrest to calling for help) and bystander cardiopulmonary resuscitation (CPR) are important factors affecting neurological recovery after out-of-hospital cardiac arrest (OHCA). This study investigated the association of the location of OHCA with the length of ATI and bystander CPR.MethodsThis population-based observational study used the nationwide Korea OHCA database and included all adults with layperson-witnessed OHCA with presumed cardiac aetiology between 2013 and 2017. The exposure was the location of OHCA (public places, private housing and nursing facilities). The primary outcome was short ATI, defined as <4 min from witnessing to calling for emergency medical service (EMS). The secondary outcome was the frequency of provision of bystander CPR. Multivariable logistic regression analysis was performed to evaluate the association of location of OHCA with study outcomes.ResultsOf 30 373 eligible OHCAs, 66.6% occurred in private housing, 24.0% occurred in public places and 9.4% occurred in nursing facilities. In 67.3% of the cases, EMS was activated within 4 min of collapse, most frequently in public places (public places 77.0%, private housing 64.2% and nursing facilities 64.8%; p<0.01). The overall rate of bystander CPR was 65.5% with highest in nursing facilities (77.0%), followed by public places (70.1%) and private housing 62.3%; p<0.01). Compared with public places, the adjusted ORs (AORs) (95% CIs) for a short ATI were 0.58 (0.54 to 0.62) in private housing and 0.62 (0.56 to 0.69) in nursing facilities. The AORs (95% CIs) for bystander CPR were 0.75 (0.71 to 0.80) in private housing and 1.57 (1.41 to 1.75) in nursing facilities.ConclusionOHCAs in private housing and nursing facilities were less likely to have immediate EMS activation after collapse than in public places. A public education is needed to increase the awareness of necessity of prompt EMS activation.

Abstract 164: Comparison of Tracheal Intubation vs. Supraglottic Airway Following Pediatric Out of Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Maryam Y Naim ◽  
Heather Griffis ◽  
Robert A Berg ◽  
Richard N Bradley ◽  
Matthew L Hansen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Hospital Discharge ◽  
Multivariable Analysis ◽  
Cerebral Performance Category ◽  
Supraglottic Airway ◽  
Secondary Outcome ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: There are few data comparing Tracheal Intubation (TI) and SupraGlottic Airway (SGA) following pediatric out of hospital cardiac arrest (OHCA). Hypothesis: TI is associated with improved outcomes compared to SGA following pediatric OHCA. Methods: Analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years, non-traumatic OHCA from 2013 through 2017, resuscitated by Emergency Medical Services (EMS). To adjust for covariate imbalance, propensity score matching and entropy balancing were utilized; variables included age category, sex, bystander CPR, and initial rhythm. Primary outcome was neurologically favorable survival defined as a cerebral performance category scale of 1 or 2. Secondary outcome was survival to hospital discharge. Results: Of 2653 cardiac arrests evaluated, 2178 (82.1%) had TI and 475 (17.9%) had SGA placed during OHCA. 835 (31.2%) arrests were resuscitated by agencies used bag valve mask (BVM) and TI and 1818 (68.0%) arrests had agencies that used all 3 airway types (BVM/TI/SGA). Overall, unadjusted favorable neurological survival was 5.7% for TI and 5.3% for SGA, p=0.67 and survival to hospital discharge was 7.9% for TI and 7.5% for SGA, p=0.73. In multivariable analysis (adjusting for age, sex, race/ethnicity, bystander witness, bystander CPR, initial rhythm, AED use, year of arrest, and agency category), SGA was associated with lower neurologically favorable survival compared to TI (adjusted proportion 3.7% vs. 6.3%, OR 0.49, p=0.01), and lower survival to hospital discharge (5.5% vs. 8.5%, OR 0.57, 95% CI 0.36, 0.89). These results were robust on tests for unmeasured confounding and covariate balance; propensity analysis neurologically favorable survival 4.4% vs.7.6% (OR 0.54, 95% CI 0.30, 0.96), survival to hospital discharge 6.6% vs.10.5% (OR 0.58, 95% CI 0.35, 0.95); and entropy balance neurologically favorable survival 5.0 % vs. 9.7% for ETI (OR 0.44, 95% CI 0.27, 0.72), survival to hospital discharge 7.3% vs.12.5% (OR 0.51, 95% CI 0.34, 0.78). Conclusion: In pediatric OHCA, TI, compared with SGA advanced airway management is associated with improved neurologically favorable survival and survival to hospital discharge.

Abstract 290: Association Between Hourly Call Volume in Emergency Medical Dispatch Center and Dispatcher -Assisted Cardiopulmonary Resuscitation Instruction Time in Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Jong Hwan Kim ◽  
Tae Han Kim ◽  
Sang Do Shin ◽  
Ki Jeong Hong ◽  
Jeong Ho Park ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Multivariable Logistic Regression Model ◽  
Emergency Medical Dispatch ◽  
Emergency Calls ◽  
Multivariable Logistic Regression ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Objectives: cardiac arrest recognition, ambulance dispatch and dispatcher assisted CPR by emergency medical dispatch (EMD) is crucial for good outcome of out-of-hospital cardiac arrest (OHCA).In EMD, crowding is caused by mismatch between numerous emergency calls and dispatchers per duty available Crowding in emergency department has been shown to decrease the performance and outcome, however little is known about effect of crowding in EMD. We aimed to evaluate incidence of crowding in emergency medical dispatch center and effect of emergency call crowding on dispatcher assisted CPR instruction performance in OHCA calls. Methods: We used nationwide OHCA database from 2013 to 2016, consisted of patients with presumed cardiac origin and dispatched by Seoul EMD. Main exposure was hourly number of total incoming emergency calls to EMD. Number of hourly calls were categorized into quartile (~4o calls, 41~51 calls, 52 ~61 calls and ~62 calls). Primary outcome was successful DA-CPR instruction provision within 120 seconds. Adjusted ratios (AORs) and 95% confidence intervals (CIs) were estimated to evaluate association between EMD crowding and outcome in multivariable logistic regression model. Results: Of a total of 12,722 patients, proportion of successful DA instruction were highest in least crowded quartile and lowest in the most crowded quartile (22.7% vs. 15.o% , p<0.01). The adjusted odds ratios is 0.85 (95% CI 0.74 - 0.98) in most crowded EMD quartile with lesser proportion of DA instruction within 120 seconds. Crowding quartile 4 and quartile 3 was associated lesser favorable neurological outcome in multivariable logistic regression model.(adjusted OR(95% CI) 0.78 (0.60-0.99) and 0.70 (0.54- 0.91) respectively) . Conclusion: Crowding in emergency medicine dispatch caused by increased hourly call volume was associated with delayed dispatcher assisted CPR instruction provision. Medical directors might consider strategy approach to solve crowding in EMD according to crowding distribution.

scholarly journals Outcomes of arrest patients resuscitated in an emergency department: a prospective, observational study

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Life Support ◽  
Survival Rates ◽  
Secondary Outcome ◽  
Time Interval ◽  
Trauma Patients ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

In developing countries, a lack of knowledge about basic life support and overcrowded emergency departments (EDs) may cause problems related to the quality of cardiopul-monary resuscitation and postresuscitation care. We aimed to investigate which factors affect the return of spontaneous circulation (ROSC) and survival rates among out-of-hospital and in-hospital arrest patients in an upper-middle income country. The study was prospectively conducted from January 2018 to April 2019. All patients resuscitated in the ED, except trauma patients, were included. The out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) groups were followed up for 30 days. The primary outcome was the 30-day-survival rate, while the secondary outcome was the ROSC rate. A total of 177 patients were included in the study (80 OHCA and 97 IHCA patients). Among the OHCA patients, ROSC was achieved at a rate of 58.8%, and a 30-day survival rate of 12.5% was observed. None of the OHCA patients underwent bystander CPR. One of the main factors affecting survival in this group was the time interval until the patient reached the ED. ROSC was achieved in 54.4% of IHCA patients, while 17.5% of them were alive at 30 days. Patients who survived 30 days were significantly younger than those who died within 30 days (56 (46–74) vs. 73 (64.2–83.7) years, respectively). In the IHCA group, patients with creatinine and potassium levels closer to normal survived for 30 days. Effective and rapid fluid-electrolyte treatments of patients with high lactate and potassium levels may improve the mortality rates of these patients. We think that a focus on improving the quality of the prehospital CPR practice in OHCA patients and increasing the rates of bystander CPR by educating the public can positively contribute to outcomes.

Abstract 306: Out-of-hospital Cardiac Arrest Response Characteristics Moderate the Effect of Response Time on Survival

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Justin J Boutilier ◽  
Clara Stoesser ◽  
Christopher L.F. Sun ◽  
Steven Brooks ◽  
Sheldon Cheskes ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Response Time ◽  
Time Delays ◽  
Logistic Regression Model ◽  
Effect Modification ◽  
Response Characteristics ◽  
Interaction Terms ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: Research has shown that each minute delay in response time reduces survival from OHCA. Although Utstein variables like public location, witnessed, bystander CPR, and bystander AED shock are known to independently improve survival, how they moderate the effect of response time delays on survival is unknown. Methods: We included OHCAs from the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database from December 1, 2005 to June 30, 2015. We included all adult, non-traumatic, non-EMS witnessed, and EMS-treated OHCA episodes. We used a logistic regression model to estimate survival to hospital discharge as a function of response time. We adjusted for standard Utstein variables and included interaction terms between response time and public location, bystander witnessed, bystander CPR, and bystander AED shock. With four binary interacted variables, there were a total of sixteen subpopulations, each with a different effect of response time on survival. Results: 83,275 patients were included (15% public, 45% witnessed, 47% CPR, 2% AED shock). Across the 10 subpopulations that comprise 99%+ of the data, a one-minute delay in response time reduced the odds of survival from 1.7% to 10.9%, depending on the arrest characteristics. All interaction tests for effect modification were significant. The reduction in odds of survival was largest for witnessed arrests (OR=0.961; 95% CI: 0.944-0.978), followed by arrests with bystander CPR (OR=0.965; 95% CI: 0.948-0.982) and in public locations (OR=0.978; 95% CI: 0.960-0.996). In contrast, a one-minute delay for arrests with bystander AED shock (OR=1.086; 95% CI: 1.058-1.114) increased the odds of survival. Conclusions: Utstein predictors significantly moderate the effect of response time on survival. Arrests that are witnessed, public location, and/or receive bystander CPR are negatively affected by slower response time. Arrests with a bystander AED shock are not sensitive to response time delays.

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