Kubota Hitomi, Amagasa Shunsuke, Kashiura Masahiro, Yasuda Hideto, Kishihara Yuki, Ishiguro Akira, Uematsu Satoko
Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan.
Department of Emergency and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan.
Prehosp Emerg Care. 2025 Feb 21:1-8. doi: 10.1080/10903127.2025.2460217.
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.
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.
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).
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.
在院外心脏骤停（OHCA）中，院前时间至关重要，可分为从紧急呼叫到紧急医疗服务（EMS）联系的响应时间，以及从EMS联系到医院到达的时间。为改善小儿OHCA的院前策略，了解这些时间间隔与患者预后之间的关联至关重要；然而，缺乏详细的调查。本研究旨在探讨小儿OHCA中响应时间、从EMS联系到医院到达的时间与生存及神经学预后之间的关联。
这项全国性回顾性分析使用了2014年6月至2021年12月期间日本OHCA登记处的数据。分析纳入了年龄＜18岁的小儿OHCA患者。主要结局为1个月生存率，次要结局为1个月时良好的神经学预后。分别进行广义相加模型分析和逻辑回归分析，并对混杂因素进行校正，以检验响应时间与患者护理时间（从EMS与患者接触到医院到达的时间）及预后之间的非线性和线性关系。
在响应时间的广义相加模型分析中，生存和神经学预后均随响应时间延长而恶化，响应时间约15分钟时预后似乎进一步下降。另一方面，患者护理时间与1个月生存率及良好的神经学预后之间存在线性关联。在逻辑回归分析中，较短的响应时间与生存（比值比[OR]：0.83，95%置信区间[CI]：0.79-0.91）及良好的神经学预后（OR：0.75，95%CI：0.59-0.93）显著相关。相比之下，从EMS联系到医院到达的时间与生存（OR：0.99，95%CI：0.97-1.02）及良好的神经学预后（OR：1.02，95%CI：0.97-1.07）无显著关联。
响应时间＜15分钟可能与更好的生存和神经学预后相关。然而，从EMS联系到医院到达的时间与生存及良好的神经学预后之间无显著关联。
