The impact of prolonged boarding of successfully resuscitated out-of-hospital cardiac arrest patients on survival-to-discharge rates

Abstract

Aim: To evaluate the effect of prolonged ED boarding of successfully resuscitated out-of-hospital cardiac arrest (OHCA) patients on their survival-to-discharge rate.

Methods: This is a retrospective nationwide cohort study of OHCA patients from 2006 to 2010. OHCA patients are classified as having those with presumed cardiac aetiology but who gained a sustained return of spontaneous circulation (ROSC). Patients who were transferred to in-hospital units within 6h after ROSC were classified in the not-delayed group (the ND group), and the remaining patients were classified as the delayed group (the D group). The survival rate between the two groups using univariate and multivariate analyses with Utstein variables was compared. We also performed a sensitivity analysis using a different time standard.

Results: During the study period, 101,463 OHCA patients were assessed by Emergency Medical Services in Korea. Of these patients, 13,330 presented with ROSC at admission, 4686 patients were selected for final analysis, 3419 were categorised in the ND group, and 1267 in the D group. After adjusting confounders with a multivariate regression model, the D group showed a significantly lower rate of survival than the ND group (OR: 0.73 [0.62-0.86]). Sensitivity analysis using different time cut-offs showed a consistently lower rate of survival in the D group, from 1 to 36h.

Conclusion: OHCA patients who were delayed in their transfer to in-patient units had a significantly lower survival-to-discharge rate.

Keywords: Crowding; Fatal outcome; Out-of-hospital cardiac arrest; Time-to-treatment.