Abstract
Purpose
To investigate temporal variations in dispatcher-assisted and bystander-initiated
resuscitation efforts and their association with survival after bystander-witnessed
out-of-hospital cardiac arrests (OHCAs).
Methods
We retrospectively analyzed the neurologically favorable 1-month survival and the
parameters related to dispatcher assisted cardiopulmonary resuscitation (DA-CPR) and
bystander CPR (BCPR) for 227,524 OHCA patients between 2007 and 2013 in Japan. DA-CPR
sensitivity for OHCAs, bystander's compliance to DA-CPR assessed by the proportion
of bystanders who follow DA-CPR, and performance of BCPR measured by the rate of bystander-initiated
CPR in patients without DA-CPR were calculated as indices of resuscitation efforts.
Results
Performance of BCPR was only similar to temporal variations in the survival (correlation
between hourly paired values, R2 = 0.263, P = 0.01): a lower survival rate (3.4% vs 4.2%) and performance of BCPR (23.1% vs 30.8%)
during night-time (22:00–5:59) than during non-night-time. In subgroup analyses based
on interaction tests, all three indices deteriorated during night-time when OHCAs
were witnessed by non-family (adjusted odds ratio, 0.73–0.82), particularly in non-elderly
patients. The rate of public access defibrillation for these OHCAs markedly decreased
during night-time (adjusted odds ratio, 0.49) with delayed emergency calls and BCPR
initiation. Multivariable logistic regression analyses revealed that the survival
rate of non-family-witnessed OHCAs was 1.83-fold lower during night-time than during
non-night-time.
Conclusions
Dispatcher-assisted and bystander-initiated resuscitation efforts are low during night-time
in OHCAs witnessed by non-family. A divisional alert system to recruit well-trained
individuals is needed in order to improve the outcomes of night-time OHCAs witnessed
by non-family bystanders.
Keywords
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Article Info
Publication History
Published online: April 03, 2018
Accepted:
March 30,
2018
Received in revised form:
February 26,
2018
Received:
December 27,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
