Brian Grunau1, Takahisa Kawano2, Frank Scheuermeyer3, John Tallon4, Joshua Reynolds5, Floyd Besserer6, David Barbic3, Steven Brooks7, Jim Christenson8. 1. Department of Emergency Medicine, University of British Columbia, BC, Canada; St. Paul's Hospital, Vancouver, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Vancouver, BC, Canada. Electronic address: Brian.Grunau2@vch.ca. 2. St. Paul's Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan. 3. Department of Emergency Medicine, University of British Columbia, BC, Canada; St. Paul's Hospital, Vancouver, BC, Canada; Centre for Health Evaluation & Outcome Sciences, Vancouver, BC, Canada. 4. Department of Emergency Medicine, University of British Columbia, BC, Canada; British Columbia Emergency Health Services, Vancouver, BC, Canada. 5. Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, United States. 6. Department of Emergency Medicine, University of British Columbia, BC, Canada; Prince George General Hospital, Prince George, BC, Canada. 7. Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada. 8. Department of Emergency Medicine, University of British Columbia, BC, Canada; St. Paul's Hospital, Vancouver, BC, Canada.
Abstract
OBJECTIVE: Data demonstrating benefit of advanced life support (ALS) practitioners for out-of-hospital cardiac arrest (OHCA) is conflicting. In our tiered emergency medical services (EMS) system, we sought to determine if the ALS response interval was associated with patient outcomes. METHODS: We performed a secondary analysis of consecutive adult OHCAs (2006-2016) in British Columbia. Primary and secondary outcomes were survival and favorable neurological outcomes (mRS ≤ 3) at hospital discharge. Logistic regression estimated the association of ALS response interval (911 call-to-ALS arrival, continuous and categorical analyses) and outcomes, adjusting for first EMS response interval, and other clinical characteristics. We calculated the optimal time threshold to differentiate "early" vs "late" ALS response intervals for a binary comparison. RESULTS: Of 12,722 included cases, 12% survived to discharge. Median response interval was 6.4 min (IQR 5.2-8.3) for the first EMS unit and 11.8 min (IQR 8.7-16.5) for ALS. ALS response interval (per minute) was associated with decreased survival (adjusted OR 0.98, 95% CI 0.96-0.99) and favourable neurological outcome (0.98, 95% CI 0.97-0.99). ALS response ≤10 min (the optimal threshold) was associated with improved survival (adjusted OR 1.46; 95% CI 1.27-1.68) and favourable neurological outcomes (adjusted OR 1.41; 95% CI 1.18-1.68). CONCLUSION: In our tiered EMS system, earlier ALS arrival was associated with improved survival and favorable neurological outcomes. ALS attendance within 10 min of the 9-1-1 call in tiered systems of prehospital care may improve patient outcomes and serve as a quality metric.
OBJECTIVE: Data demonstrating benefit of advanced life support (ALS) practitioners for out-of-hospital cardiac arrest (OHCA) is conflicting. In our tiered emergency medical services (EMS) system, we sought to determine if the ALS response interval was associated with patient outcomes. METHODS: We performed a secondary analysis of consecutive adult OHCAs (2006-2016) in British Columbia. Primary and secondary outcomes were survival and favorable neurological outcomes (mRS ≤ 3) at hospital discharge. Logistic regression estimated the association of ALS response interval (911 call-to-ALS arrival, continuous and categorical analyses) and outcomes, adjusting for first EMS response interval, and other clinical characteristics. We calculated the optimal time threshold to differentiate "early" vs "late" ALS response intervals for a binary comparison. RESULTS: Of 12,722 included cases, 12% survived to discharge. Median response interval was 6.4 min (IQR 5.2-8.3) for the first EMS unit and 11.8 min (IQR 8.7-16.5) for ALS. ALS response interval (per minute) was associated with decreased survival (adjusted OR 0.98, 95% CI 0.96-0.99) and favourable neurological outcome (0.98, 95% CI 0.97-0.99). ALS response ≤10 min (the optimal threshold) was associated with improved survival (adjusted OR 1.46; 95% CI 1.27-1.68) and favourable neurological outcomes (adjusted OR 1.41; 95% CI 1.18-1.68). CONCLUSION: In our tiered EMS system, earlier ALS arrival was associated with improved survival and favorable neurological outcomes. ALS attendance within 10 min of the 9-1-1 call in tiered systems of prehospital care may improve patient outcomes and serve as a quality metric.
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