Effect of time of day on prehospital care and outcomes after out-of-hospital cardiac arrest
Sarah K Wallace1, Benjamin S Abella, Frances S Shofer
1Department of Emergency Medicine, Hospital of the University of Pennsylvania, Ground Ravdin, 3400 Spruce St, Philadelphia, PA 19104, USA. roger.band@uphs.upenn.edu
Circulation
|March 20, 2013
Summary
Out-of-hospital cardiac arrests (OHCA) occurring during the day have higher 30-day survival rates than those at night. This finding suggests potential implications for emergency medical services resource allocation and patient outcomes during cardiac emergencies.
Area of Science:
- Emergency Medicine
- Cardiology
- Public Health
Background:
- Over 300,000 out-of-hospital cardiac arrests (OHCA) occur annually in the U.S.
- The impact of time of day on OHCA outcomes is not well understood.
- Understanding this relationship is crucial for optimizing emergency medical services (EMS).
Purpose of the Study:
- To investigate the association between the time of day and OHCA outcomes.
- To determine if OHCA survival rates differ between daytime and nighttime events.
- To inform EMS resource allocation strategies.
Main Methods:
- Retrospective analysis of OHCA data from a large urban EMS system (2008-2012).
- Inclusion criteria: adult OHCA, excluding traumatic arrests and non-resuscitation cases.
- Statistical analysis using relative risk regression, adjusting for key survival predictors.
Main Results:
- A total of 4789 OHCA cases were analyzed; 41% occurred at night (8 PM - 7:59 AM).
- No significant difference in prehospital return of spontaneous circulation between day and night OHCA.
- Significantly lower 30-day survival rates for nighttime OHCA (8.56%) compared to daytime (10.9%).
Conclusions:
- Daytime OHCA are associated with significantly higher 30-day survival rates than nighttime OHCA.
- This difference persists even after adjusting for patient, event, and prehospital care factors.
- The findings highlight a potential circadian variation in OHCA survival.
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