The association of the post-resuscitation on-scene interval and patient outcomes after out-of-hospital cardiac arrest

After resuscitation from out-of-hospital cardiac arrest (OHCA) by Emergency Medical Services (EMS), the amount of time that should be dedicated to pre-transport stabilization is unclear. We examined whether the time spent on-scene after return of spontaneous circulation (ROSC) was associated with pa...

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Bibliographic Details
Published in:	Resuscitation Vol. 188; p. 109753
Main Authors:	Khan, Laiba, Hutton, Jacob, Yap, Justin, Dodek, Peter, Scheuermeyer, Frank, Asamoah-Boaheng, Michael, Heidet, Matthieu, Wall, Nechelle, Fordyce, Christopher B., van Diepen, Sean, Christenson, Jim, Grunau, Brian
Format:	Journal Article
Language:	English
Published:	Ireland Elsevier B.V 01.07.2023
Subjects:	Adult Cardiopulmonary Resuscitation Emergency Medical Services Humans Logistic Models Out-of-Hospital Cardiac Arrest Post-resuscitation care Registries Out-of-hospital cardiac arrest Emergency medical services Post-resuscitation care
ISSN:	0300-9572, 1873-1570, 1873-1570
Online Access:	Get full text
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Summary:	After resuscitation from out-of-hospital cardiac arrest (OHCA) by Emergency Medical Services (EMS), the amount of time that should be dedicated to pre-transport stabilization is unclear. We examined whether the time spent on-scene after return of spontaneous circulation (ROSC) was associated with patient outcomes. We examined consecutive adult EMS-treated OHCAs from the British Columbia Cardiac Arrest registry (January 1/2019-June 1/2021) that had on-scene ROSC (sustained to scene departure). The primary outcome was favourable neurological outcome (Cerebral Performance Category ≤ 2) at hospital discharge; secondary outcomes were re-arrest during transport and hospital-discharge survival. Using adjusted logistic regression models, we estimated the association between the post-resuscitation on-scene interval (divided into quartiles) and outcomes. Of 1653 cases, 611 (37%) survived to hospital discharge, and 523 (32%) had favourable neurological outcomes. The median post-resuscitation on-scene interval was 18.8 minutes (IQR:13.0–25.5). Compared to the first post-resuscitation on-scene interval quartile, neither the second (adjusted odds ratio [AOR] 1.19; 95% CI 0.72–1.98), third (AOR 1.10; 95% CI 0.67–1.81), nor fourth (AOR 1.54; 95% CI 0.93–2.56) quartiles were associated with favourable neurological outcomes; however, the fourth quartile was associated with a greater odds of hospital-discharge survival (AOR 1.73; 95% CI 1.05–2.85), and both the third (AOR 0.40; 95% CI 0.22–0.72) and fourth (AOR 0.44;95% CI 0.24–0.81) quartiles were associated with a lower odds of intra-transport re-arrest. Among resuscitated OHCAs, increased post-resuscitation on-scene time was not associated with improved neurological outcomes, but was associated with improved survival to hospital discharge and decreased intra-transport re-arrest.
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ISSN:	0300-9572 1873-1570 1873-1570
DOI:	10.1016/j.resuscitation.2023.109753