Emergency response time after out-of-hospital cardiac arrest

Funada

2018

JAHA

BackgroundThe response time of emergency medical services (EMS) is an important determinant of survival after out‐of‐hospital cardiac arrest. We sought to identify upper limits of EMS response times and bystander interventions associated with neurologically intact survival.Methods and ResultsWe analyzed the records of 553 426 patients with out‐of‐hospital cardiac arrest in a Japanese registry between 2010 and 2014. The primary study end point was 1‐month neurologically intact survival (Cerebral Performance Category scale 1 or 2). Increased EMS response time was associated with significantly decreased adjusted odds of 1‐month neurologically intact survival (adjusted odds ratio [aOR] for each 1‐minute increase, 0.89; 95% confidence interval [CI], 0.89–0.90), although this relationship was modified by bystander interventions. The bystander interventions and the ranges of EMS response times that were associated with increased adjusted 1‐month neurologically intact survival were as follows: bystander defibrillation, from ≤2 minutes (aOR, 3.10 [95% CI, 1.25–7.31]) to 13 minutes (aOR, 5.55 [95% CI, 2.66–11.2]); bystander conventional cardiopulmonary resuscitation, from 3 minutes (aOR 1.48 [95% CI, 1.02–2.12]) to 11 minutes (aOR 2.41 [95% CI, 1.61–3.56]); and bystander chest‐compression‐only cardiopulmonary resuscitation, from ≤2 minutes (aOR 1.57 [95% CI, 1.01–2.25]) to 11 minutes (aOR 1.92 [95% CI, 1.45–2.56]). However, the increase in neurologically intact survival of those receiving bystander interventions became statistically insignificant compared with no bystander interventions when the EMS response time was outside these ranges.ConclusionsThe upper limits of the EMS response times associated with improved 1‐month neurologically intact survival were 13 minutes when bystanders provided defibrillation (typically with cardiopulmonary resuscitation) and 11 minutes when bystanders provided cardiopulmonary resuscitation without defibrillation.

Section: Discussionsupporting

confidence: 93%

Relationship Between Emergency Medical Services Response Time and Bystander Intervention in Patients With Out‐of‐Hospital Cardiac Arrest

Funada

2018

JAHA

“…Application of an AED by a layperson before the arrival of EMS providers on scene, 48 briefer time from the call for assistance to the arrival of EMS providers on scene (ie, response time interval), [49][50][51][52][53][54] and better quality of CPR [55][56][57][58][59][60][61] are associated with improved outcomes.…”

Section: Ems Responsementioning

confidence: 99%

Out-of-Hospital Cardiac Arrest Resuscitation Systems of Care: A Scientific Statement From the American Heart Association

McCarthy¹,

Carr²,

Sasson³

et al. 2018

Circulation

ABSTRACT:The American Heart Association previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, emergency medical services, and hospital efforts to measure and improve the process of care and outcome for patients with cardiac arrest. In addition, the American Heart Association proposed a national process to develop and implement evidence-based guidelines for cardiac resuscitation systems of care. Significant experience has been gained with implementing these systems, and new evidence has accumulated. This update describes recent advances in the science of cardiac resuscitation systems and evidence of their effectiveness, as well as recent progress in dissemination and implementation throughout the United States. Emphasis is placed on evidence published since the original recommendations (ie, including and since 2010). Cardiac arrest is loss of mechanical activity of the heart confirmed by the absence of signs of circulation.1 Approximately 356 461 people are treated for out-of-hospital cardiac arrest (OHCA) annually in the United States.2 One third of cases occur without any prior recognized heart disease; half occur without any prodromal symptoms.3 Despite robust systems of care for patients with trauma and rapidly evolving systems of care for patients with ST-segment-elevation myocardial infarction (STEMI) and stroke, the majority of communities do not achieve optimal survival after OHCA because of large discrepancies in resuscitation-related processes of care.4-6 As a result, survival to hospital discharge varies significantly both across different regions and by presenting rhythm. 7,8 Survival increases significantly if the OHCA is quickly recognized and responded to with prompt activation of 9-1-1, bystander-initiated cardiopulmonary resuscitation (CPR), bystander and/or basic first responder application of an automated external defibrillator (AED) before arrival of other emergency medical services (EMS) providers on scene, advanced life support, and postresuscitation care. The American Heart Association (AHA) previously recommended implementation of cardiac resuscitation systems of care that consist of interconnected community, EMS, and hospital efforts to measure and improve the process and outcome of care for patients with cardiac arrest.10 Simultaneously, the AHA proposed a national process to develop and implement evidence-based guidelines for the implementation and measurement of such systems. The 2015 AHA guidelines for CPR and emergency cardiovascular care delved deeper into the elements of an effective system of care for both OHCA and in-hospital cardiac arrest.11 This update on OHCA resuscitation systems of care describes recent advances, evidence

The American Journal of Emergency Medicine

“…In contrast to response time, the transportation time widely varied and there was no [5,23]. Furthermore, a previous study showed that a short response time (less than 6 min) could lead to a high survival rate [24].…”

Section: Comparisons Of Ohca Outcomes Managed Without Prehospital Aclmentioning

confidence: 99%

“…Although reducing the response time may improve OHCA outcomes [3][4][5][6][7], there are only a few ways to achieve it. For example, response times can be improved by increasing the number of ambulance teams and fire department offices, or by equipping additional first-line responders with defibrillators, such as the fire fighters and police services [8,9].…”

Section: Introductionmentioning

confidence: 99%

The fast emergency vehicle pre-emption system improved the outcomes of out-of-hospital cardiac arrest

Tanaka¹,

Yamada²,

Tamasaku³

et al. 2013

Purposes: Ambulance response time is a major factor associated with survival in out-of-hospital cardiac arrests (OHCAs); the fast emergency vehicle pre-emption system (FAST TM ) aids response time by controlling traffic signals. This eight-year observational study investigated whether FAST TM implementation reduced response times and improved OHCA outcomes. Results:The median response time significantly differed between the FAST TM -equipped and non-FAST TM -equipped groups at 327 and 381 s, respectively. The 1-Y survival rates were 7.0% in the FAST TM -equipped group and 2.8% in the non-FAST TM -equipped group. Logistic regression analysis revealed that the dispatch of a FAST TM -equipped ambulance was an independent factor for 1-Y survival (adjusted odds ratio = 3.077, 95% confidence interval = 1.180-9.350). Conclusions:The FAST TM implementation significantly reduced ambulance response times and improved OHCA outcomes in Kanazawa city. (Word count: 231)