Abstract
Background
Conflicting ideas exist about whether or not Emergency Medical Service (EMS) personnel
should treat a cardiac arrest on scene or transport immediately.
Objective
Our aim was to examine patient outcomes before and after an urban EMS system implemented
a protocol change mandating a 30-min scene time interval (STI) for out-of-hospital
cardiac arrest (OHCA).
Methods
This was a retrospective, single-center, observational study of OHCA patients before
and after an EMS protocol change mandating resuscitation on scene. Data were retrieved
from an EMS cardiac arrest database for all adults with non-traumatic OHCA between
January 2015 and August 2016. Descriptive statistics were used to summarize the study
population, and a regression model was used to determine the associations of the protocol
with the return of spontaneous circulation (ROSC).
Results
A total of 633 patients were included in the study population, which was primarily
male (61.3%) with a mean age of 65 years. After the 30-min STI was implemented, ROSC
from OHCA increased to 40.1% of cases compared to 27.3% before the protocol change
(p = 0.001; 95% confidence interval [CI] 0.053–0.203). The STI increased from 19 min
23 s to 29 min 40 s in the pre and post periods, respectively (p < 0.001). Regression indicated that the protocol change was independently associated
with an improved chance of ROSC (OR 1.81; 95% CI 1.23–2.64).
Conclusions
A protocol change mandating a 30-min STI in OHCA correlated with increased STI and
increased ROSC. While increased ROSC may not always equate with positive neurologic
outcome, logistic regression indicated that the protocol change was independently
associated with improved ROSC at emergency department arrival.
Keywords
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Article info
Publication history
Published online: August 28, 2019
Accepted:
June 15,
2019
Received in revised form:
May 16,
2019
Received:
February 14,
2019
Footnotes
Meetings: Lightening Oral Abstract, Society of Academic Emergency Medicine, 2017.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
