Abstract
BackgroundDespite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) cases have an average survival rate of only 12% nationwide, compared to 24.8% of cases occurring in hospital. Many factors, including resuscitation interventions, contribute to positive patient outcomes and have, therefore, been studied in attempts to optimize emergency medical services (EMS) protocols to achieve higher rates of return of spontaneous circulation (ROSC) in the field. However, no consensus has been met regarding the appropriate amount of time for EMS to spend on scene.AimA favorable outcome is defined as patients that achieved the combination of ROSC and a final disposition of “ongoing resuscitation in the emergency department (ED).” The primary purpose of this preliminary study was to determine the scene time interval (STI) in which American urban EMS systems achieved the highest rates of favorable outcomes in non-traumatic OOHCAs.MethodsAll EMS-related data, including demographics, presenting rhythm, airway management, chemical interventions, and ROSC were recorded using a standardized EMS charting system by the highest-ranking EMS provider on the ambulance. The reports were retrospectively collected and analyzed.ConclusionOur data suggest that the optimal 20-minute STI for OOHCA patients in an urban EMS system is between 41 and 60 minutes. Interestingly, the 10-minute interval within the 41-60 minute cohort that provided the highest rate of ROSC was between 41 and 50 minutes. Generally, the longer the STI, the greater the percentage of favorable outcomes up to the 50-minute mark. Once past 50 minutes, a phenomenon of diminishing return was observed and the rates of favorable outcomes sharply declined. This suggests a possible “sweet spot” that may exist regarding the optimal scene time in a cardiac arrest encounter. Significant differences between the average number of interventions per patient were found, however, many confounding factors and the limited data set make the results difficult to generalize.
Highlights
Out-of-hospital cardiac arrest (OOHCA) is a life-threatening emergency that affects approximately 350,000 Americans a year [1]
Favorable outcome is defined as patients that achieved the combination of return of spontaneous circulation (ROSC) and "ongoing resuscitation in the emergency department (ED)." The overall percent favorable outcome was 36.98%, which is consistent among each time interval except the 41-60 scene time interval (STI) in which the percent increased to 51.61%
Favorable outcome is defined as patients that achieved the combination of ROSC and "ongoing resuscitation in the ED." The 0-10 minute STI was eliminated from analysis since there was no data for that period
Summary
Out-of-hospital cardiac arrest (OOHCA) is a life-threatening emergency that affects approximately 350,000 Americans a year [1]. Despite advances in resuscitation science and public health, OOHCA has an average survival rate of only 12% nationwide, compared to 24.8% of patients who suffer from cardiac arrest while in hospital [1]. Some prior studies attempted to establish an ideal STI to optimize patient outcomes, most were conducted in Asia [5,6,7]. The aim of this preliminary study is to identify the scene time interval most associated with positive patient outcomes suffering from cardiac arrest in an urban, paramedic-staffed EMS system in the US. No consensus has been met regarding the appropriate amount of time for EMS to spend on scene
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