Warning symptoms preceding out-of-hospital cardiac arrest

Do patient delays matter?

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Background Although increasing patient delays between symptom onset and activation of emergency medical services (EMS) can lead to poorer outcomes following acute myocardial infarction, its effect in out-of-hospital cardiac arrest (OHCA) populations is unclear. Methods Between 1st January 2003 and 31st December 2011, we included adult patients with anginal warning symptoms and subsequent EMS witnessed OHCA of presumed cardiac aetiology from the Victorian Ambulance Cardiac Arrest Registry. Multivariable logistic regression was used to assess the impact of patient delay time (i.e. symptom onset to EMS call time) on survival to hospital discharge. Results A total of 1056 EMS witnessed OHCA were screened, of which 515 (48.8%) reported chest pain or anginal equivalent symptoms. The median patient delay time was 25 min (interquartile range [IQR] 9–89 min), and did not differ across survivors and non-survivors. However, patients in lowest quartile of patient delay (≤8 min) also experienced significantly higher rates of non-shockable arrest rhythms and circulatory compromise. A total of 16 baseline and clinical characteristics were tested in a multivariable model of survival to hospital discharge, of which, only six were retained in the final model, including: age, dyspnoea, vomiting, shockable arrest rhythm, systolic blood pressure, and patient delay time. Every 30 min increase in patient delay time was independently associated with a 2.3% (95% CI: 0.4%, 4.1%; p = 0.02) reduction in the odds of survival to hospital discharge. Among patients with ST-segment deviation on the pre-arrest ECG, every 30 min increase in patient delay time was associated with a 3.4% reduction in the odds of survival (OR 0.966, 95% CI: 0.937, 0.996; p = 0.03). Conclusion Increasing delays in activating EMS before the onset OHCA may be associated with reduced survival. Future research could explore whether increasing public awareness of the warning symptoms leads to earlier medical contact for OHCA.

Original languageEnglish
Pages (from-to)65-70
Number of pages6
JournalResuscitation
Volume123
DOIs
Publication statusPublished - 1 Feb 2018

Keywords

  • Cardiac arrest
  • Emergency medical services
  • Patient delay time
  • Prodromal symptoms
  • Treatment delay

Cite this

@article{98bf858fd48b42178bf7255a64a123b5,
title = "Warning symptoms preceding out-of-hospital cardiac arrest: Do patient delays matter?",
abstract = "Background Although increasing patient delays between symptom onset and activation of emergency medical services (EMS) can lead to poorer outcomes following acute myocardial infarction, its effect in out-of-hospital cardiac arrest (OHCA) populations is unclear. Methods Between 1st January 2003 and 31st December 2011, we included adult patients with anginal warning symptoms and subsequent EMS witnessed OHCA of presumed cardiac aetiology from the Victorian Ambulance Cardiac Arrest Registry. Multivariable logistic regression was used to assess the impact of patient delay time (i.e. symptom onset to EMS call time) on survival to hospital discharge. Results A total of 1056 EMS witnessed OHCA were screened, of which 515 (48.8{\%}) reported chest pain or anginal equivalent symptoms. The median patient delay time was 25 min (interquartile range [IQR] 9–89 min), and did not differ across survivors and non-survivors. However, patients in lowest quartile of patient delay (≤8 min) also experienced significantly higher rates of non-shockable arrest rhythms and circulatory compromise. A total of 16 baseline and clinical characteristics were tested in a multivariable model of survival to hospital discharge, of which, only six were retained in the final model, including: age, dyspnoea, vomiting, shockable arrest rhythm, systolic blood pressure, and patient delay time. Every 30 min increase in patient delay time was independently associated with a 2.3{\%} (95{\%} CI: 0.4{\%}, 4.1{\%}; p = 0.02) reduction in the odds of survival to hospital discharge. Among patients with ST-segment deviation on the pre-arrest ECG, every 30 min increase in patient delay time was associated with a 3.4{\%} reduction in the odds of survival (OR 0.966, 95{\%} CI: 0.937, 0.996; p = 0.03). Conclusion Increasing delays in activating EMS before the onset OHCA may be associated with reduced survival. Future research could explore whether increasing public awareness of the warning symptoms leads to earlier medical contact for OHCA.",
keywords = "Cardiac arrest, Emergency medical services, Patient delay time, Prodromal symptoms, Treatment delay",
author = "Ziad Nehme and Stephen Bernard and Emily Andrew and Peter Cameron and Bray, {Janet E.} and Karen Smith",
year = "2018",
month = "2",
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doi = "10.1016/j.resuscitation.2017.12.019",
language = "English",
volume = "123",
pages = "65--70",
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}

Warning symptoms preceding out-of-hospital cardiac arrest : Do patient delays matter? / Nehme, Ziad; Bernard, Stephen; Andrew, Emily; Cameron, Peter; Bray, Janet E.; Smith, Karen.

In: Resuscitation, Vol. 123, 01.02.2018, p. 65-70.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Warning symptoms preceding out-of-hospital cardiac arrest

T2 - Do patient delays matter?

AU - Nehme, Ziad

AU - Bernard, Stephen

AU - Andrew, Emily

AU - Cameron, Peter

AU - Bray, Janet E.

AU - Smith, Karen

PY - 2018/2/1

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N2 - Background Although increasing patient delays between symptom onset and activation of emergency medical services (EMS) can lead to poorer outcomes following acute myocardial infarction, its effect in out-of-hospital cardiac arrest (OHCA) populations is unclear. Methods Between 1st January 2003 and 31st December 2011, we included adult patients with anginal warning symptoms and subsequent EMS witnessed OHCA of presumed cardiac aetiology from the Victorian Ambulance Cardiac Arrest Registry. Multivariable logistic regression was used to assess the impact of patient delay time (i.e. symptom onset to EMS call time) on survival to hospital discharge. Results A total of 1056 EMS witnessed OHCA were screened, of which 515 (48.8%) reported chest pain or anginal equivalent symptoms. The median patient delay time was 25 min (interquartile range [IQR] 9–89 min), and did not differ across survivors and non-survivors. However, patients in lowest quartile of patient delay (≤8 min) also experienced significantly higher rates of non-shockable arrest rhythms and circulatory compromise. A total of 16 baseline and clinical characteristics were tested in a multivariable model of survival to hospital discharge, of which, only six were retained in the final model, including: age, dyspnoea, vomiting, shockable arrest rhythm, systolic blood pressure, and patient delay time. Every 30 min increase in patient delay time was independently associated with a 2.3% (95% CI: 0.4%, 4.1%; p = 0.02) reduction in the odds of survival to hospital discharge. Among patients with ST-segment deviation on the pre-arrest ECG, every 30 min increase in patient delay time was associated with a 3.4% reduction in the odds of survival (OR 0.966, 95% CI: 0.937, 0.996; p = 0.03). Conclusion Increasing delays in activating EMS before the onset OHCA may be associated with reduced survival. Future research could explore whether increasing public awareness of the warning symptoms leads to earlier medical contact for OHCA.

AB - Background Although increasing patient delays between symptom onset and activation of emergency medical services (EMS) can lead to poorer outcomes following acute myocardial infarction, its effect in out-of-hospital cardiac arrest (OHCA) populations is unclear. Methods Between 1st January 2003 and 31st December 2011, we included adult patients with anginal warning symptoms and subsequent EMS witnessed OHCA of presumed cardiac aetiology from the Victorian Ambulance Cardiac Arrest Registry. Multivariable logistic regression was used to assess the impact of patient delay time (i.e. symptom onset to EMS call time) on survival to hospital discharge. Results A total of 1056 EMS witnessed OHCA were screened, of which 515 (48.8%) reported chest pain or anginal equivalent symptoms. The median patient delay time was 25 min (interquartile range [IQR] 9–89 min), and did not differ across survivors and non-survivors. However, patients in lowest quartile of patient delay (≤8 min) also experienced significantly higher rates of non-shockable arrest rhythms and circulatory compromise. A total of 16 baseline and clinical characteristics were tested in a multivariable model of survival to hospital discharge, of which, only six were retained in the final model, including: age, dyspnoea, vomiting, shockable arrest rhythm, systolic blood pressure, and patient delay time. Every 30 min increase in patient delay time was independently associated with a 2.3% (95% CI: 0.4%, 4.1%; p = 0.02) reduction in the odds of survival to hospital discharge. Among patients with ST-segment deviation on the pre-arrest ECG, every 30 min increase in patient delay time was associated with a 3.4% reduction in the odds of survival (OR 0.966, 95% CI: 0.937, 0.996; p = 0.03). Conclusion Increasing delays in activating EMS before the onset OHCA may be associated with reduced survival. Future research could explore whether increasing public awareness of the warning symptoms leads to earlier medical contact for OHCA.

KW - Cardiac arrest

KW - Emergency medical services

KW - Patient delay time

KW - Prodromal symptoms

KW - Treatment delay

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DO - 10.1016/j.resuscitation.2017.12.019

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