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Effect of awareness time interval for out-of-hospital cardiac arrest on outcomes: A nationwide observational study.
Resuscitation 2019; 147:43-52R

Abstract

PURPOSE

Awareness of out-of-hospital cardiac arrest (OHCA) is critically important for bystanders to receive early instruction of dispatch-assisted cardiopulmonary resuscitation (DA-CPR) as well as to call for ambulance services. This study aimed to determine the association between awareness time interval and outcomes.

METHODS

EMS-treated, witnessed, adult (≥18 years old) OCHAs with presumed cardiac etiology between 2012 and 2017 were analyzed, excluding patients with unknown awareness time factors and outcomes. The main exposure was awareness time interval (ATI), defined as the time from the witnessed event to calling for ambulance. Patients were categorized into five groups according to ATI: Group 1 (0-1 min), Group 2 (2-3 min), Group 3 (4-5 min), Group 4 (6-30 min) and Group 5 (31-60 min). The primary outcome was good neurological recovery defined as cerebral performance category 1 or 2 (good CPC). Multivariable logistic regression analysis was performed to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for outcomes by ATI group (reference = Group 1) and by one-minute delay. We compared the effect size of ATI on outcomes across three witness groups (Layperson, Family, and Unknown).

RESULTS

A total of 36,809 OHCAs were analyzed. The AOR (95% CI) by one-minute ATI delay was 0.91 (0.90-0.92) for good CPC. The AORs (95% CIs) for outcomes compared with Group 1 were 0.98 (0.88-1.09) for Group 2, 0.64 (0.56-0.74) for Group 3, 0.30 (0.26-0.35) for Group 4, and 0.10 (0.05-0.20) for Group 5. In the Family bystander group, AORs (95% CIs) compared with Group 1 were significantly decreased by delay of ATI; 1.04 (0.88-1.11) for Group 2, 0.63 (0.81-0.83) for Group 3, and 0.31 (0.31-0.40) for Group 4 and 5. In Layperson-witnessed OHCAs, however, the AORs were significantly higher in the delayed awareness groups (Group 2 and Group 3).

CONCLUSION

A longer ATI in witnessed adult OHCAs was associated with poor neurological recovery. A one-minute delay in ATI was associated with a 9% decrease of good neurological recovery, and the effect was significantly increased in Family-witnessed OHCAs.

Authors+Show Affiliations

Department of Emergency Medicine, Jeju National University Hospital, Republic of Korea. Electronic address: 9meho84@gmail.com.Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea. Electronic address: shinsangdo@gmail.com.Department of Emergency Medicine, Seoul National University Boramae Medical Center, Republic of Korea. Electronic address: skciva@gmail.com.Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea. Electronic address: timthe@gmail.com.Department of Emergency Medicine, Dongkuk University Ilsan Hospital, Republic of Korea. Electronic address: scl0126@daum.net.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31870923

Citation

Ko, Seo Young, et al. "Effect of Awareness Time Interval for Out-of-hospital Cardiac Arrest On Outcomes: a Nationwide Observational Study." Resuscitation, vol. 147, 2019, pp. 43-52.
Ko SY, Shin SD, Song KJ, et al. Effect of awareness time interval for out-of-hospital cardiac arrest on outcomes: A nationwide observational study. Resuscitation. 2019;147:43-52.
Ko, S. Y., Shin, S. D., Song, K. J., Park, J. H., & Lee, S. C. (2019). Effect of awareness time interval for out-of-hospital cardiac arrest on outcomes: A nationwide observational study. Resuscitation, 147, pp. 43-52. doi:10.1016/j.resuscitation.2019.12.009.
Ko SY, et al. Effect of Awareness Time Interval for Out-of-hospital Cardiac Arrest On Outcomes: a Nationwide Observational Study. Resuscitation. 2019 Dec 20;147:43-52. PubMed PMID: 31870923.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of awareness time interval for out-of-hospital cardiac arrest on outcomes: A nationwide observational study. AU - Ko,Seo Young, AU - Shin,Sang Do, AU - Song,Kyoung Jun, AU - Park,Jeong Ho, AU - Lee,Seung Chul, Y1 - 2019/12/20/ PY - 2019/04/20/received PY - 2019/11/26/revised PY - 2019/12/09/accepted PY - 2019/12/25/pubmed PY - 2019/12/25/medline PY - 2019/12/25/entrez KW - Awareness time KW - Bystander KW - Out-of-hospital cardiac arrest KW - Outcomes SP - 43 EP - 52 JF - Resuscitation JO - Resuscitation VL - 147 N2 - PURPOSE: Awareness of out-of-hospital cardiac arrest (OHCA) is critically important for bystanders to receive early instruction of dispatch-assisted cardiopulmonary resuscitation (DA-CPR) as well as to call for ambulance services. This study aimed to determine the association between awareness time interval and outcomes. METHODS: EMS-treated, witnessed, adult (≥18 years old) OCHAs with presumed cardiac etiology between 2012 and 2017 were analyzed, excluding patients with unknown awareness time factors and outcomes. The main exposure was awareness time interval (ATI), defined as the time from the witnessed event to calling for ambulance. Patients were categorized into five groups according to ATI: Group 1 (0-1 min), Group 2 (2-3 min), Group 3 (4-5 min), Group 4 (6-30 min) and Group 5 (31-60 min). The primary outcome was good neurological recovery defined as cerebral performance category 1 or 2 (good CPC). Multivariable logistic regression analysis was performed to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for outcomes by ATI group (reference = Group 1) and by one-minute delay. We compared the effect size of ATI on outcomes across three witness groups (Layperson, Family, and Unknown). RESULTS: A total of 36,809 OHCAs were analyzed. The AOR (95% CI) by one-minute ATI delay was 0.91 (0.90-0.92) for good CPC. The AORs (95% CIs) for outcomes compared with Group 1 were 0.98 (0.88-1.09) for Group 2, 0.64 (0.56-0.74) for Group 3, 0.30 (0.26-0.35) for Group 4, and 0.10 (0.05-0.20) for Group 5. In the Family bystander group, AORs (95% CIs) compared with Group 1 were significantly decreased by delay of ATI; 1.04 (0.88-1.11) for Group 2, 0.63 (0.81-0.83) for Group 3, and 0.31 (0.31-0.40) for Group 4 and 5. In Layperson-witnessed OHCAs, however, the AORs were significantly higher in the delayed awareness groups (Group 2 and Group 3). CONCLUSION: A longer ATI in witnessed adult OHCAs was associated with poor neurological recovery. A one-minute delay in ATI was associated with a 9% decrease of good neurological recovery, and the effect was significantly increased in Family-witnessed OHCAs. SN - 1873-1570 UR - https://www.unboundmedicine.com/medline/citation/31870923/Effect_of_awareness_time_interval_for_out-of-hospital_cardiac_arrest_on_outcomes:_A_nationwide_observational_study L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(19)30732-4 DB - PRIME DP - Unbound Medicine ER -