Abstract 323: Time to Specialized Prehospital Care and Neurologically Favorable Survival After Traumatic Out-Of-Hospital Cardiac Arrest: Results From a Japanese Registry-Based Study

Abstract

Introduction: Specialized care is essential for successful resuscitation after traumatic out-of-hospital cardiac arrest (OHCA). However, the effect of early specialized care by healthcare professional for traumatic OHCA in the prehospital setting is unknown. Hypothesis: We sought to determine whether time to specialized prehospital care by healthcare professional is associated with a neurological status after traumatic OHCA. Methods: This was a nationwide population-based study of traumatic OHCA based on data from the All-Japan Utstein Registry. We included patients who experienced traumatic OHCA in Japan from 2013 to 2016. The primary outcome was 1-month neurologically favorable survival. Results: A total of 8,470 patients were included. Among these patients, 50 (0.6%) survived with a favorable neurological status one month after OHCA. The median time to specialized prehospital care by healthcare professional was 9 minutes (IQR, 7-13; mean [SD], 10.7 [6.3] minutes). Longer time to specialized prehospital care was associated with a decreased chance of neurologically favorable survival: 2.6, 1.2, 0.9, 0.5, 0.2, and 0.0%, respectively, when time to specialized prehospital care was treated as a categorical variable categorized into ≤2, 3-5, 6-8, 9-11, 12-14, and ≥15 minutes (P for trend <0.0001), and multivariable-adjusted OR per minute delay 0.79 (95%CI 0.70-0.89, P<0.0001) when time to specialized prehospital care was treated as a linear and continuous variable. In subgroup analyses, longer time to specialized care was associated with a decreased chance of neurologically favorable survival when ALS was provided in the prehospital setting (adjusted OR 0.73, 95%CI 0.61-0.87, P=0.0007), especially when prehospital ALS was performed by physician (adjusted OR 0.72, 95%CI 0.56-0.93, P=0.0119), whereas there was no significant association between time to specialized care and neurologically favorable survival when only BLS was provided in the prehospital setting (adjusted OR 0.86, 95%CI 0.74-1.01, P=0.0734). Conclusion: In traumatic OHCA, delayed specialized prehospital care by healthcare professional was associated with a decreased chance of neurologically favorable survival, especially when a physician was involved in prehospital ALS.