Effect of awareness time interval for out-of-hospital cardiac arrest on outcomes: A nationwide observational study

Seo Young Ko, Sang Do Shin, Kyoung Jun Song, Jeong Ho Park, Seung Chul Lee

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)43-52
Number of pages10
JournalResuscitation
Volume147
DOIs
StatePublished - 1 Feb 2020

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Out-of-Hospital Cardiac Arrest
Observational Studies
Odds Ratio
Confidence Intervals
Ambulances
Cardiopulmonary Resuscitation
Logistic Models
Regression Analysis

Keywords

  • Awareness time
  • Bystander
  • Out-of-hospital cardiac arrest
  • Outcomes

Cite this

@article{9750d52ba0bf4039ba307841093cddd5,
title = "Effect of awareness time interval for out-of-hospital cardiac arrest on outcomes: A nationwide observational study",
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.",
keywords = "Awareness time, Bystander, Out-of-hospital cardiac arrest, Outcomes",
author = "Ko, {Seo Young} and Shin, {Sang Do} and Song, {Kyoung Jun} and Park, {Jeong Ho} and Lee, {Seung Chul}",
year = "2020",
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Effect of awareness time interval for out-of-hospital cardiac arrest on outcomes : A nationwide observational study. / Ko, Seo Young; Shin, Sang Do; Song, Kyoung Jun; Park, Jeong Ho; Lee, Seung Chul.

In: Resuscitation, Vol. 147, 01.02.2020, p. 43-52.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of awareness time interval for out-of-hospital cardiac arrest on outcomes

T2 - A nationwide observational study

AU - Ko, Seo Young

AU - Shin, Sang Do

AU - Song, Kyoung Jun

AU - Park, Jeong Ho

AU - Lee, Seung Chul

PY - 2020/2/1

Y1 - 2020/2/1

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.

AB - 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.

KW - Awareness time

KW - Bystander

KW - Out-of-hospital cardiac arrest

KW - Outcomes

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U2 - 10.1016/j.resuscitation.2019.12.009

DO - 10.1016/j.resuscitation.2019.12.009

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JO - Resuscitation

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