Abstract
Background
After resuscitation from out-of-hospital cardiac arrest (OHCA) by Emergency Medical
Services (EMS), the amount of time that should be dedicated to pre-transport stabilization
is unclear. We examined whether the time spent on-scene after return of spontaneous
circulation (ROSC) was associated with patient outcomes.
Methods
We examined consecutive adult EMS-treated OHCAs from the British Columbia Cardiac
Arrest registry (January 1/2019-June 1/2021) that had on-scene ROSC (sustained to
scene departure). The primary outcome was favourable neurological outcome (Cerebral
Performance Category ≤ 2) at hospital discharge; secondary outcomes were re-arrest
during transport and hospital-discharge survival. Using adjusted logistic regression
models, we estimated the association between the post-resuscitation on-scene interval
(divided into quartiles) and outcomes.
Results
Of 1653 cases, 611 (37%) survived to hospital discharge, and 523 (32%) had favourable
neurological outcomes. The median post-resuscitation on-scene interval was 18.8 minutes
(IQR:13.0–25.5). Compared to the first post-resuscitation on-scene interval quartile,
neither the second (adjusted odds ratio [AOR] 1.19; 95% CI 0.72–1.98), third (AOR
1.10; 95% CI 0.67–1.81), nor fourth (AOR 1.54; 95% CI 0.93–2.56) quartiles were associated
with favourable neurological outcomes; however, the fourth quartile was associated
with a greater odds of hospital-discharge survival (AOR 1.73; 95% CI 1.05–2.85), and
both the third (AOR 0.40; 95% CI 0.22–0.72) and fourth (AOR 0.44;95% CI 0.24–0.81)
quartiles were associated with a lower odds of intra-transport re-arrest.
Conclusion
Among resuscitated OHCAs, increased post-resuscitation on-scene time was not associated
with improved neurological outcomes, but was associated with improved survival to
hospital discharge and decreased intra-transport re-arrest.
Keywords
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Article info
Publication history
Published online: February 24, 2023
Accepted:
February 20,
2023
Received in revised form:
February 16,
2023
Received:
December 5,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
