Association of the duration of on-scene advanced life support with good neurological recovery in out-of-hospital cardiac arrest.

Abstract

As advanced life support (ALS) provided by emergency medical services (EMS) on scene becomes more common, the scene time interval (STI) for which EMS providers stay on scene tends to lengthen. We investigated the relationship between the STI and neurological outcome of patients at hospital discharge when ALS was provided by EMS on scene. We conducted a retrospective analysis of prospectively collected out-of-hospital cardiac arrest (OHCA) data between August 2015 and December 2018. A restricted cubic spline curve was used to investigate the relationship between the STI and neurologic outcome, and patients were divided into two groups based on the cut-off value obtained through receiver operating characteristic (ROC) analysis. Comparisons of outcomes between the two groups were performed before and after propensity score matching. 4548 patients were included in the analysis. In ROC analysis, the optimal cut-off value for STI was 19min. For the group with an STI <19min, survival admission, survival discharge, and good neurologic outcome at hospital discharge were all higher than for the group with STI ≥19min before and after propensity score matching. The multivariable model also showed that the STI ≥19min was significantly associated with poor neurologic outcome at hospital discharge compared with the STI <19min (adjusted odds ratio, 2.00; 95% CI, 1.40-2.88). A duration of on-scene ALS more than 19min was associated with a poor neurologic outcome of patients at hospital discharge in OHCA.