The association between scene time interval and neurologic outcome following adult bystander witnessed out-of-hospital cardiac arrest - 29/07/21

Doi : 10.1016/j.ajem.2020.11.059

Ryan A. Coute, DO ^a,^{^⁎} , Brian H. Nathanson, PhD ^b, Michael C. Kurz, MD ^a,^c,^d, Bryan McNally, MD MPH ^e, Timothy J. Mader, MD ^f
The CARES Surveillance Group^g
^a Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States of America
^b OptiStatim, LLC, Longmeadow, MA, United States of America
^c Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, United States of America
^d Center for Injury Science, University of Alabama School of Medicine, Birmingham, AL, United States of America
^e Department of Emergency Medicine, Emory University, Atlanta, GA, United States of America
^f Department of Emergency Medicine, University of Massachusetts Medical School—Baystate, Springfield, MA, United States of America
^g Cardiac Arrest Registry to Enhance Survival (CARES) Surveillance Group, Atlanta, GA, United States of America

^⁎Corresponding author at: Department of Emergency Medicine, The University of Alabama at Birmingham, Old Hillman Building, Suite 251, 619 19th Street South, Birmingham, AL 35249, United States of America.Department of Emergency MedicineThe University of Alabama at BirminghamOld Hillman BuildingSuite 251619 19th Street SouthBirminghamAL35249United States of America

Abstract

Objective

To analyze the association between Emergency Medical Services (EMS) scene time interval (STI) and survival with functional neurologic recovery following adult out-of-hospital cardiac arrest (OHCA).

Methods

A retrospective analysis of prospectively collected data from the national Cardiac Arrest Registry to Enhance Survival from January 2013 to December 2018. All adult non-traumatic, EMS-treated, bystander-witnessed OHCA with complete data were included. Patients with STI times >60 min, defined as the time from EMS arrival at the patient's side to the time the transport vehicle left the scene, unwitnessed OHCA, nursing home events, EMS-witnessed OHCA, or patients with termination of resuscitation in the field were excluded. The primary outcome was survival with functional recovery (Cerebral Performance Category [CPC] = 1 or 2). Multivariable logistic regression was used to quantify the association of STI with the primary.

outcome.

Results

67,237 patients met inclusion criteria with 12,098 (18.0%) surviving with functional recovery. Mean STI (SD) for survivors with CPC 1 or 2 was 19 (8.4) and 22.8 (10.5) for those with poor outcomes (death or CPC 3–4; p < 0.001). For every 1-min increase in STI, the adjusted odds of a poor outcome increased by 3.5%; odds ratio = 1.035; 95% CI (1.027, 1.044); p < 0.001. Restricted cubic spline analysis showed increased risk of poor outcome after approximately 20 min.

Conclusion

Longer STI times are strongly associated with poor neurologic outcome in bystander-witnessed OHCA patients. After a STI duration of approximately 20 min, the associated risk of a poor neurologic outcome increased more rapidly.

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Keywords : Emergency medical services, Out-of-hospital cardiac arrest, Neurologic outcome