Outcomes and modifiable resuscitative characteristics amongst pan-Asian out-of-hospital cardiac arrest occurring at night
Journal
Medicine
Journal Volume
98
Journal Issue
10
Date Issued
2019-03
Author(s)
Ho, Andrew Fu Wah
Hao, Ying
Pek, Pin Pin
Shahidah, Nur
Yap, Susan
Ng, Yih Yng
Wong, Kwanhathai Darin
Lee, Eui Jung
Khruekarnchana, Pairoj
Wah, Win
Liu, Nan
Tanaka, Hideharu
Shin, Sang Do
Ong, Marcus Eng Hock
PAROS Clinical Research Network+
Julina M.N.
Hisamuddin N.A.R.
Naroo G.Y.
Omer A.S.
Yagdir T.
Khunkhlai N.
Monsomboon A.
Piyasuwankul T.
Nishiuchi T.
Kajino K.
Nakagawa T.
Ryoo, Hyun Wook
Song K.J.
Mao D.R.H.
Goh E.S.
Tham L.P.
Cheah S.O.
Chia M.Y.C.
Gan H.N.
Tiah L.
Leong B.S.H.
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.
Subjects
automated external defibrillator; bystander cardiopulmonary resuscitation; circadian patterns; out-of-hospital cardiac arrest; AMERICAN-HEART-ASSOCIATION; MEDICAL-SERVICES SYSTEMS; HEALTH-PROFESSIONALS; CIRCADIAN VARIATION; SURVIVAL; DEFIBRILLATION; GUIDELINES; STATEMENT; COUNTRIES; UPDATE
SDGs
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Type
journal article