Association Between Response Time and Time from Emergency Medical Service Contact with the Patient to Hospital Arrival as well as Survival and Neurological Outcomes in Pediatric Out-of-Hospital Cardiac Arrest.

Abstract

Objectives: In out-of-hospital cardiac arrest (OHCA), prehospital time is crucial and can be divided into response time, from emergency call to emergency medical service (EMS) contact, and time from EMS contact to hospital arrival. To improve prehospital strategies for pediatric OHCA, it is essential to understand the association between these time intervals and patient outcomes; however, detailed investigations are lacking. The current study aimed to examine the association between response time and time from EMS contact to hospital arrival as well as survival and neurological outcomes in pediatric OHCA.

Methods: This nationwide retrospective analysis used data from an OHCA registry in Japan between June 2014 and December 2021. Pediatric patients aged <18 years who had OHCA were included in the analysis. The primary outcome was 1-month survival, and the secondary outcome was 1-month favorable neurological outcome. Generalized additive model analyses and logistic regression analyses, adjusted for confounders, were performed to examine the non-linear and linear relationship between response time and patient care time (time from EMS contact with the patient to hospital arrival) and outcomes, respectively.

Results: In the generalized additive model analyses of response time, both survival and neurological outcomes worsened with response time, with outcomes appearing to further decline with a response time of approximately 15 min. On the other hand, there was a linear association between patient care time as well as 1-month survival and favorable neurologic outcomes. In logistic regression analyses, shorter response times were significantly associated with survival (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.79-0.91]) and a favorable neurological outcome (OR: 0.75, 95% CI: 0.59-0.93). In contrast, time from EMS contact to hospital arrival was not significantly associated with survival (OR: 0.99, 95% CI: 0.97-1.02) and favorable neurological outcomes (OR: 1.02, 95% CI: 0.97-1.07).

Conclusions: A response time of <15 min can be associated with better survival and neurological outcomes. However, there is no significant association between time from EMS contact to hospital arrival as well as survival and favorable neurological outcomes.