Conflicting ideas exist about whether or not Emergency Medical Service (EMS) personnel should treat a cardiac arrest on scene or transport immediately.
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).
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).
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).
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Heart disease and stroke statistics-2015 update: a report from the American Heart Association.Circulation. 2015; 131: 29-39
- Out-of-hospital cardiac arrest survival improving over time: results from the Resuscitation Outcomes Consortium (ROC).Resuscitation. 2015; 91: 108-115
- Modifiable factors associated with survival after out-of-hospital cardiac arrest in the Pan-Asian Resuscitation Outcomes Study.Ann Emerg Med. 2018; 71: 608-617.e15
- Spatial variation and resuscitation process affecting survival after out-of-hospital cardiac arrests (OHCA).PLoS One. 2015; 10 (Available at: http://www.ncbi.nlm.nih.gov/pubmed/26659851%5Cn; http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4682793. Accessed April 30 2018): e0144882
- The role of bystanders, first responders, and emergency medical service providers in timely defibrillation and related outcomes after out-of-hospital cardiac arrest: results from a statewide registry.Resuscitation. 2015; 96: 303-309
- Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010–2013.JAMA. 2015; 314: 255-264
- Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: a systematic review and meta-analysis.Resuscitation. 2015; 96 (Available at:): 66-77https://doi.org/10.1016/j.resuscitation.2015.07.036Date accessed: April 30, 2018
- Quality between mechanical compression on reducible stretcher versus manual compression on standard stretcher in small elevator.Am J Emerg Med. 2016; 34: 1604-1609
- Quality of mechanical, manual standard and active compression-decompression CPR on the arrest site and during transport in a manikin model.Resuscitation. 1997; 34: 235-242
- Quality of cardiopulmonary resuscitation before and during transport in out-of-hospital cardiac arrest.Resuscitation. 2008; 76: 185-190
- Effect of vehicle speed on the quality of closed-chest compression during ambulance transport.Resuscitation. 2010; 81 (Available at:): 841-847https://doi.org/10.1016/j.resuscitation.2010.02.024Date accessed: April 30, 2018
- CPR quality during out-of-hospital cardiac arrest transport.Resuscitation. 2017; 114 (Available at:): 34-39https://doi.org/10.1016/j.resuscitation.2017.02.016Date accessed: April 30, 2018
- The effect of transport on quality of cardiopulmonary resuscitation in out-of-hospital cardiac arrest.Resuscitation. 2009; 80: 843-848
- CPR variability during ground ambulance transport of patients in cardiac arrest.Resuscitation. 2013; 84 (Available at:): 592-595https://doi.org/10.1016/j.resuscitation.2012.07.042Date accessed: April 30, 2018
- The use of emergency lights and sirens by ambulances and their effect on patient outcomes and public safety: a comprehensive review of the literature.Prehosp Disaster Med. 2017; 32: 209-216
- Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest.JAMA. 2013; 309 (Available at:): 257http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2012.187612Date accessed: April 30, 2018
- Association between resuscitation time interval at the scene and neurological outcome after out-of-hospital cardiac arrest in two Asian cities.Resuscitation. 2014; 95: 203-210
- Impact of cardiopulmonary resuscitation duration on survival from paramedic witnessed out-of-hospital cardiac arrests: an observational study.Resuscitation. 2016; 100 (Available at:): 25-31https://doi.org/10.1016/j.resuscitation.2015.12.011Date accessed: April 30, 2018
- Age-specific differences in the duration of prehospital cardiopulmonary resuscitation administered by emergency medical service providers necessary to achieve favorable neurological outcome after out-of-hospital cardiac arrest.Circ J. 2017; 81 (Available at:): 652-659https://www.jstage.jst.go.jp/article/circj/81/5/81_CJ-16-1251/_articleDate accessed: April 30, 2018
- Relationship between the duration of cardiopulmonary resuscitation and favorable neurological outcomes after out-of-hospital cardiac arrest: a prospective, nationwide, population-based cohort study.J Am Heart Assoc. 2016; 5 (Available at:): e002819http://jaha.ahajournals.org/lookup/doi/10.1161/JAHA.115.002819Date accessed: April 30, 2018
- Scene time interval and good neurological recovery in out-of-hospital cardiac arrest.Am J Emerg Med. 2017; 35: 1682-1690
Published online: August 28, 2019
Accepted: June 15, 2019
Received in revised form: May 16, 2019
Received: February 14, 2019
Meetings: Lightening Oral Abstract, Society of Academic Emergency Medicine, 2017.
© 2019 Elsevier Inc. All rights reserved.