(1516) Redefining Early Defibrillation: Arrest-to-Shock Time and Outcomes in Bystander-Treated OHCA

Monday, February 24, 2025

2:30pm – 3:30pm Eastern Time

Location: Connections Central - RST 10

First Author(s)

tomonao yoshida, M.D.

Japanese Society of Intensive Care Medicine
sapporo, Hokkaido, JPN

Co-Author(s)

kunihiko maekawa, M.D. (he/him/his)

Assistant Professor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University
Sapporo, United States
YUKI MUNEKATA, M.D.

Sapporo-shi, Hokkaido, JPN
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yuma fukuhara, M.D.

senior resident
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
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yurika kakizaki, M.D.

senior resident
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
mm

mone murashita, M.D.

Senior Resident
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
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shohei tanaka, M.D.

attending doctor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
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masaki takahashi, M.D.

Attending Doctor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
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takumi tsuchida, M.D./Ph.D.

Attending Doctor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
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asumi mizugaki, M.D./Ph.D.

Attending Doctor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
ST

Shuhei Takauji, M.D./Ph.D.

Attending Doctor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
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mariko hayamizu, M.D./Ph.D.

Specially Appointed Assistant Professor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
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yoshinori honma, M.D.

Specially Appointed Assistant Professor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
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tomoyo saito, M.D./Ph.D.

Specially Appointed Assistant Professor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
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kenichi katabami, M.D./Ph.D.

Assistant Professor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
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mineji hayakawa, M.D./Ph.D.

Associate Professor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States
TW

Takeshi Wada, M.D./Ph.D.

Professor
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hokkaido University, United States

Introduction:

Introduction: Early defibrillation is recommended for out-of-hospital cardiac arrest (OHCA) patients with shockable rhythms. However, this strategy is based on a fundamental study from 30 years ago, and its effectiveness in contemporary patients still needs to be verified.

Methods:

Methods: We analyzed witnessed OHCA of presumed cardiac etiology where bystander chest compressions and public-access defibrillation (PAD) were performed, as recorded in the Japanese nationwide Utstein registry in 2021. We investigated the relationship between the arrest-to-shock (ATS) time and outcomes (prehospital return of spontaneous circulation [ROSC], survival, and favorable neurological status at 30 days) using multivariate logistic regression and restricted cubic spline analysis.

Results:

Results: The study included 936 eligible patients. The mean age was 66, with 74.4% male patients. Layperson-witnessed arrests accounted for 40% of cases. The mean ATS time was 5.5 minutes, with bystander-delivered shocks. Upon EMS arrival, 25% of patients had shockable rhythms. Prehospital ROSC was achieved in 45%, survival in 35%, and favorable neurological outcomes in 25% of patients.
Multivariate analysis revealed that ATS time was significantly associated with ROSC and neurological outcomes (adjusted odds ratios per 1 minute increase: 0.96 [95%CI 0.93-0.99, p = 0.03] and 0.95 [0.91-0.99, p = 0.038], respectively) but not with survival (0.96 [0.93-1.00, p = 0.065]). Spline analysis showed non-linear relationships between ATS time and outcomes, with unimodal peaks for survival and favorable neurological outcomes.

Conclusions:

Conclusions: In this contemporary real-world data, each minute delay in the ATS time was associated with an approximately 5% decrease in ROSC rates and favorable neurological outcomes at 30 days. The non-linear relationship between the ATS time and outcomes suggests that delaying defibrillation by about 5 minutes may improve outcomes.