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EMS agencies spending more time on scene for out-of-hospital cardiac arrest (OOHCA) patients had better outcomes. Higher on-scene time was linked to increased return of spontaneous circulation (ROSC), survival, and good neurologic function.

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Public Health

Background:

  • Out-of-hospital cardiac arrest (OOHCA) management strategies vary, with some prioritizing rapid transport and others extended on-scene resuscitation.
  • The optimal duration of on-scene care for OOHCA remains a critical question in emergency medical services (EMS).

Purpose of the Study:

  • To compare patient outcomes between EMS agencies with high on-scene time (HOSTAs) and low on-scene time (LOSTAs) for OOHCA management.
  • To investigate the association between the duration of on-scene resuscitation efforts and patient survival and neurological outcomes.

Main Methods:

  • Utilized the Cardiac Arrest Registry to Enhance Survival (CARES) database for OOHCA cases from 2013-2017.
  • Categorized 178 EMS agencies into HOSTAs (≥25 minutes on scene) and LOSTAs (<18.9 minutes on scene) based on average on-scene duration.
  • Employed generalized estimating equation models to compare outcomes between HOSTAs and LOSTAs, controlling for patient characteristics.

Main Results:

  • HOSTAs had significantly higher rates of return of spontaneous circulation (ROSC) upon emergency department arrival (66.7% vs. 31.1%).
  • Patients treated by HOSTAs demonstrated improved survival to discharge (22.3% vs. 11.2%) and better neurological outcomes among survivors (84.9% vs. 78.6%).
  • HOSTAs were more likely to treat patients with shockable rhythms, witnessed arrests, and those who received bystander CPR.

Conclusions:

  • Extended on-scene resuscitation time in OOHCA management is associated with more favorable patient outcomes.
  • Higher on-scene times correlate with increased ROSC, survival to discharge, and good neurological recovery.
  • Findings suggest a potential benefit to longer on-scene interventions for OOHCA patients.