Characteristics and outcomes of out-of-hospital sudden cardiac arrest according to the time of occurrence. (July 2017)

• Record Type: Journal Article
• Authors: Karam, Nicole; Marijon, Eloi; Dumas, Florence; Offredo, Lucile; Beganton, Frankie; Bougouin, Wulfran; Jost, Daniel; Lamhaut, Lionel; Empana, Jean-Philippe; Cariou, Alain; Spaulding, Christian; Jouven, Xavier
• Is Part Of: Resuscitation. Volume 116(2017)
• Page Start: 16
• Page End: 21
• Publication Date: 2017-07
• Subjects: Resuscitation -- Sudden death -- Survival -- Education -- Community; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2017.04.024
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Purpose: The impact of time of occurrence has been extensively evaluated for in-hospital cardiac arrests but less for Out-of-Hospital Cardiac Arrests (OHCA). We assessed the impact of the time of occurrence on the characteristics and prognosis of OHCA. Methods: Using data from the Paris Sudden Cardiac Death Expertise Center prospective study that includes all OHCA in the Paris Area, we compared characteristics and outcomes of off-hours OHCA (nights and days off) to regular-hours OHCA between 2011 and 2014. Results: Among a total of 9834 OHCA (70.0 ± 17 years old, 62.1% males), off-hours OHCA accounted for 63.4%. Although bystanders were more often present (74.4 vs. 72.1%, P = 0.01), rates of bystander CPR (46.7 vs. 50.6%, P = 0.001) and AED use (1.0 vs. 1.9%, P = 0.01) were lower during off-hours. While EMS arrival delays were similar, patients were less often in shockable rhythm (16.3 vs. 19.1%, P < 0.0001), and return of spontaneous circulation was less frequent (27.5 vs. 31.1%, P < 0.0001). There was no difference in rates of targeted temperature control (54.8 vs. 54.7%, P = 0.75), coronary angiography (57.3 vs. 58.2%, P = 0.68) and angioplasty use (32.2 vs. 35.6%, P = 0.22). Survival at hospital discharge was lower (4.7 vs. 6.5%, P < 0.0001) during off-hours. After adjusting for potential confounders, time of occurrence was not associated with worse outcome (OR 0.85, 95% CI 0.69–1.06, P = 0.15), and bystander-initiated CPR, shockable initial rhythm and AED use were the main survival predictors (P < 0.0001). Conclusion: Off-hours OHCA have a 30% lower survival rate, mainly due to differences in initial management (bystander CPR and AED use), illustrating the need to improve bystanders' responsiveness in all circumstances.