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Background: Rapid emergency medical service (EMS) response after out-of-hospital cardiac arrest (OHCA) is a major determinant of survival, however this is typically measured until EMS vehicle arrival. We sought to investigate whether the interval from EMS vehicle arrival to patient attendance (curb-to-care interval [CTC]) was associated with patient outcomes.Methods: We performed a secondary analysis of the "CCC Trial" dataset, which includes EMS-treated adult non-traumatic OHCA. We fit an adjusted logistic regression model to estimate the association between CTC interval (divided into quartiles) and the primary outcome (survival with favourable neurologic status at hospital discharge; mRS ≤ 3). We described the CTC interval distribution among enrolling clusters.Results: We included 24,685 patients: median age was 68 (IQR 56-81), 23% had initial shockable rhythms, and 7.6% survived with favourable neurological status. Compared to the first quartile (≤62 s), longer CTC quartiles (63-115, 116-180, and ≥181 s) demonstrated the following associations with survival with favourable neurological status: adjusted odds ratios 0.95, 95% CI 0.83-1.09; 0.77, 95% CI 0.66-0.89; 0.66, 95% CI 0.56-0.77, respectively. Of the 49 study clusters, median CTC intervals ranged from 86 (IQR 58-130) to 179 s (IQR 112-256).Conclusion: A lower CTC interval was associated with improved patient outcomes. These results demonstrate a wide range of access metrics within North America, and provide a rationale to create protocols to mitigate access obstacles. A 2-min CTC threshold may represent an appropriate target for quality improvement. [ABSTRACT FROM AUTHOR]

Background: Certain subgroups of patients with out-of-hospital cardiac arrest (OHCA) may not benefit from treatment. Early identification of this cohort in the prehospital (EMS) setting prior to any resuscitative efforts would prevent futile medical therapy and more appropriately allocate EMS and hospital resources. We sought to validate a clinical criteria from Bokutoh, Japan that identified a subgroup of OHCAs for whom withholding resuscitation may be appropriate.Methods: We performed a secondary analysis of the "Trial of Continuous or Interrupted Chest Compressions during CPR", which enrolled EMS-treated adult non-traumatic OHCA. We classified patients as per the Bokutoh criteria ("Bokutoh Positive": age ≥ 73, unwitnessed arrest, non-shockable initial rhythm) and calculated test performance for the primary outcome of favourable neurologic outcome (mRS ≤ 3) at hospital discharge. We calculated the number of EMS-hours and hospital days per patient with a favourable neurologic outcome.Results: Of 26,148 patients in the parent trial, 5442 (21%) were "Bokutoh Positive", among whom 0.51% (95% CI 0.35- 0.75%) had favourable neurologic outcomes, and 1.2% (95% CI 0.92-1.5%) survived. The positive predictive value was 0.995 (95% CI 0.992-0.997). EMS and hospital-based resource utilization per favourable neurological outcome was 91 h and 199 days for in the "Bokutok Positive" group, respectively, and 5.7 h and 33 hospital days in the "Bokutok Negative" group.Conclusion: In this validation of the Bokutoh criteria in a large North American cohort of OHCA patients, 0.51% meeting criteria had favourable neurological outcomes. This may rapidly and reliably identify the one-fifth of OHCA who are very unlikely to benefit from resuscitation. [ABSTRACT FROM AUTHOR]