Association between Survival and Time of On-Scene Resuscitation in Refractory Out-of-Hospital Cardiac Arrest: A Cross-Sectional Retrospective Study.

Hang Park,Ki Ahn,Ju Park,Eui Lee

doi:10.3390/ijerph18020496

Abstract

It is estimated that over 60% of out-of-hospital cardiac arrest (OHCA) patients with a shockable rhythm are refractory to current treatment, never achieve return of spontaneous circulation, or die before they reach the hospital. Therefore, we aimed to identify whether field resuscitation time is associated with survival rate in refractory OHCA (rOHCA) with a shockable initial rhythm. This cross-sectional retrospective study extracted data of emergency medical service (EMS)-treated patients aged ≥ 15 years with OHCA of suspected cardiac etiology and shockable initial rhythm confirmed by EMS providers from the OHCA registry database of Korea. A multivariable logistic regression analysis was conducted for survival to discharge and good neurological outcomes in the scene time interval groups. The median scene time interval for the non-survival and survival to discharge patients were 16 (interquartile range (IQR) 13–21) minutes and 14 (IQR 12–16) minutes, respectively. In this study, for rOHCA patients with a shockable rhythm, continuing CPR for more than 15 min on the scene was associated with a decreased chance of survival and good neurological outcome. In particular, we found that in the patients whose transport time interval was >10 min, the longer scene time interval was negatively associated with the neurological outcome.

Highlights

Despite significant advances in resuscitation science and practice, survival following out-of-hospital cardiac arrest (OHCA) is still low
It was shown that the association between scene time and good neurological outcome differed depending on the transport time
In our study, we showed that when the Transport time interval (TTI) is > 10 min, the longer scene time interval (STI) was negatively associated with the neurological outcome in refractory OHCA (rOHCA) patients

Summary

Introduction

Despite significant advances in resuscitation science and practice, survival following out-of-hospital cardiac arrest (OHCA) is still low. In Korea, the number of OHCA cases in 2016 was 29,832, and the rate of survival was 7.6% [1]. 350,000 deaths annually, and the rate of survival to hospital discharge was 10.5% in 2017 [2]. The survival rate of these patients was 29.3% in 2017 in the US [2]. Shockable rhythms are known to be strongly associated with improved survival rates compared to non-shockable rhythms in OHCA [3,4]. It is estimated that more than 60% of OHCA patients with shockable rhythm are refractory to resuscitation and fail to achieve prehospital return of spontaneous circulation (ROSC) [5]

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