Outcomes and modifiable resuscitative characteristics amongst pan-Asian out-of-hospital cardiac arrest occurring at night

Abstract

Studies are divided on the effect of day-night temporal differences on clinical outcomes in out-of-hospital cardiac arrest (OHCA). This study aimed to elucidate any differences in OHCA survival between day and night occurrence, and the factors associated with differences in survival.This was a prospective, observational study of OHCA cases across multinational Pan-Asian sites. Cases were divided according to time call received by dispatch centers into day (0700H–1900H) and night (1900H–0659H). Primary outcome was 30-day survival. Secondary outcomes were prehospital and hospital modifiable resuscitative characteristics.About 22,501 out of 55,881 cases occurred at night. Night cases were less likely to be witnessed (40.2% vs. 43.1%, P < .001), more likely to occur at home (32.5% vs. 29%, P < .001), had non-shockable initial rhythms (90.8% vs. 89.4%, P < .001), lower bystander CPR rates (36.2 vs. 37.6%, P = .001), lower bystander AED application rate (0.3% vs. 0.7%, P < .001), lower rates of prehospital defibrillation (13% vs. 14.4%, P < .001), and were less likely to receive prehospital adrenaline (9.8% vs. 11%, P < .001). 30-day survival at night was lower with an adjusted odds ratio of 0.79 (95% CI 0.73–0.86, P < .001). On multivariate logistic regression, occurrence at night was associated with decreased provision of bystander CPR, bystander AED application, and prehospital adrenaline.30-day survival was worse in OHCA occurring at night. There were circadian patterns in incidence. Bystander CPR and bystander AED application were significantly lower at night in multivariate analysis. This would at least partially explain the decreased survival at night.

Association Between Modifiable Prehospital Prognostic Factors on Out-Of-Hospital Cardiac Arrest in Different Age Groups

“…Prehospital de brillation was also a prognostic factor for OHCA [2,10]. Our study found that prehospital de brillation was associated with a higher chance of survival for the younger group than that for the older group.…”

“…The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor, with the survival rate ranging from 2-11% in the Asia-Paci c area [1]. Many prehospital factors in uence the outcomes of OHCA, such as witnessing the OHCA, bystander cardiopulmonary resuscitation (CPR), initial heart rhythm, level of hospital care, location, and time of OHCA [2][3][4][5].…”

Nation-Wide Observational Study of Cardiac Arrests Occurring in Nursing Homes and Nursing Facilities in Singapore

“…Non-cardiac aetiologies included respiratory conditions, electrocution, drowning and other causes such as cancer and renal disease. Covariates were determined based on a literature review of possible confounders and/or known prognostic factors, [15][16][17][18][19] and were adjusted for in regression analyses. For presumed cardiac and non-cardiac aetiologies, 2 multivariate models were constructed to reflect postulated differences in incidence of aetiologies in NH and non-NH groups and different prognosticating factors.…”

Mortality and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Patients With and Without Targeted Temperature Management in a Multiethnic Asian Population

“…As prehospital defibrillation and CPR performed by EMS/private ambulance are of significance in reducing mortality, possible measures to increase these may be to educate lay people on where to find and use automated external defibrillators and to regularly ensure our paramedics are up-to-date with their CPR skills. 25 These findings as a whole strongly support a focus on basic life support measures through community and prehospital intervention to increase prompt and effective CPR and automated external defibrillator use, which have far greater effect on outcomes. [25][26][27] Although there was some suggestion that TTM improved mortality and CPC in our study population, there was insufficient power to demonstrate statistical significance.…”

“…25 These findings as a whole strongly support a focus on basic life support measures through community and prehospital intervention to increase prompt and effective CPR and automated external defibrillator use, which have far greater effect on outcomes. [25][26][27] Although there was some suggestion that TTM improved mortality and CPC in our study population, there was insufficient power to demonstrate statistical significance. We postulate that TTM may not have been complete in many patients and complications may not have been accounted for.…”