Association between prehospital time and in-hospital outcomes in out-of-hospital cardiac arrests according to resuscitation outcomes consortium epidemiologic registry

• Published in: Heart & lung 2024-03, Vol.64, p.168-175
• Main Authors: Pu, Yuting, Chai, Xiangping, Yang, Guifang
• Format: Article
• Language: English
• Subjects: Mortality; Out-of-hospital cardiac arrest; Outcome; Prehospital time; Unfavorable neurological function
• ISSN: 0147-9563; 1527-3288; 1527-3288
• DOI: 10.1016/j.hrtlng.2024.01.004

•The effect of prehospital time in out-of-hospital cardiac arrests (OHCAs) on their outcomes was assessed from total prehospital time, emergency medical system (EMS) response time, advance life support response time, EMS first chest compression (CPR) time and other time of EMS's interventions.•The outcome of OHCAs was not only in-hospital death, but also adverse neurological function and comorbidities in surviving patients.•The association between prehospital time and pre-hospital death for OHCAs and the occurrence of complications in deceased patients was also assessed. For out-of-hospital cardiac arrests (OHCAs), time is of the essence. While the relationship between EMS response time (ERT) and OHCA outcomes is well studied, a more comprehensive assessment of the effects of other intervention time is needed, which is essential to guide clinical practice. Evaluating how a longer total pre-hospital time (TPT), ERT, advance life support response time (ART) and EMS cardiopulmonary resuscitation time (ECT) increase the mortality rates, unfavorable neurological outcomes, and severe complications at discharge of OHCAs. 31,926 OHCAs from the USA and Canada were identified in Resuscitation Outcomes Consortium Epidemiologic Registry. Twelve adjusted models were used to analyze the relationship between the prehospital time (TPT, ERT, ART and ECT) and three outcomes (in hospital mortality, unfavorable neurological outcomes, and severe complications for surviving OHCAs). Every 10-min increase in TPT was associated with a 0.14-fold increase in the risk of death (adjusted odds ratio [OR] = 1.14, 95 % confidence interval [CI] = 1.10–1.17) and a 0.13-fold increase of adverse neurological outcomes (OR = 1.13, CI =1.08–1.18). The risk of patient mortality markedly increased with every 5 min increase in ERT (OR = 1.36, CI = 1.26–1.47), ART (OR =1.10, CI = 1.06–1.15), and ECT (OR = 1.46, CI = 1.37–1.56). Adverse neurological outcome was associated with ERT and ECT, and severe complications with ERT and ART. Prolonged prehospital time, particularly ERT and ECT, are closely associated with in-hospital mortality, unfavorable neurological functions, and severe complications at discharge in OHCAs.