Abstract
Background: Whether arrival time is associated with in-hospital managements and outcomes in patients out-of-cardiac arrest (OHCA) due to acute myocardial infarction (AMI) is still unclear. Methods: We conducted a multi-institutional, observational study (JAAM-OHCA study) of OHCA from June 2014 through December 2015 in Japan. The primary exposure was hospital arrival time divided into three groups, defining weekday regular time as 8:00 AM to 4:59 PM, weekday night time as 5:00PM to 7:59AM, and weekends/holidays as Saturday, Sunday and holidays. The outcome measures were in-hospital managements (i.e., percutaneous coronary intervention [PCI], intra-aortic balloon pump [IABP], extracorporeal cardiopulmonary resuscitation [ECPR], and target temperature management [TTM]), and neurologically intact survival at 30-day. To determine the associations of hospital arrival time with these outcomes, we constructed logistic regression models adjusting for patient characteristics, out-of-hospital care and in-hospital care, with generalized estimating equations accounting for patient clustering within hospitals. Results: We recruited 13,491 patients with OHCA. Of these, 852 had return of spontaneous circulation and was diagnosed as AMI; n=299 arrived during weekday regular time; n=265 arrived during weekday night time; n=288 arrived during weekends or holidays. Finally, a total of 219 (25.7%) OHCA patients had neurologically intact survival at 30-day. The rates of in-hospital management were not different among the three groups except IABP use (P<0.01). Compared to patients arrived during weekday regular time, neurologically intact survival rate at 30-day was not significantly different in patients arrived during weekday night time and weekends/holiday (26.1% [78 of 299] in weekday regular time group, 22.6% [60 of 265] in weekday night time group, and 28.1% [81 of 288] in weekends/holidays group) with corresponding adjusted odds ratios of 0.80 (95% confidence interval [CI] 0.45-1.40; P=0.43) and 0.96 (95% CI 0.57-1.63; P=0.89). Conclusion: In this observational study of adult patients with OHCA due to AMI, in-hospital managements and outcomes were not differed across hospital arrival time groups.
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