Abstracts for the 2019 NAEMSP Scientific Assembly

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.