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Cardiac arrest survival lower on weekends
PHILADELPHIA — Individuals who experience out-of-hospital cardiac arrest are less likely to survive to hospital admission on weekends compared with weekdays, according to findings presented at the American Heart Association Scientific Sessions.
Researchers found that, after adjustment for age, sex and location of event, patients who experience out-of-hospital cardiac arrest are approximately 20% less likely to survive to hospital admission between 12 a.m. Saturday and 11:59 p.m. Sunday (OR = 0.81; 95% CI, 0.68-0.95).
Moreover, researchers observed a negative association between survival and out-of-hospital cardiac arrest that occurred at home (OR = 0.32; 95% CI, 0.1-0.94) and increasing age per 1-year increase (OR = 0.99; 95% CI, 0.98-1), according to the study.
“It is often said that sudden cardiac arrest can happen to anyone, anytime, anywhere,” Hannah Torney, PhD student at Ulster University in Northern Ireland and clinical engineer at HeartSine Technologies in Belfast, said in a press release. “These results suggest that there is an opportunity to address sudden cardiac arrests that occur during the weekend by improving automated external defibrillator awareness, availability and training and quick response by rescuers.”
In other findings, there was no association between first shock success from a public access defibrillator, with success being defined as termination of shockable rhythm for 5 seconds after shock, and day of the week.
In addition, there was also no association found between out-of-hospital cardiac arrest and the time of day when the event occurred.
Researchers assessed 3,400 patients (median age, 63 years; 72% men) with the aim of highlighting a relationship between out-of-hospital cardiac arrest and survival of patients when admitted at night or on weekends. According to the study, 1,127 first shocks were delivered and success of first shock was 87.2%. Also, survival outcomes were reported for 2,942 patients, with approximately 27% of patients surviving to hospital admission.
“Out-of-hospital cardiac arrest patients are significantly less likely to survive to hospital admission at weekends compared to weekdays,” the researchers wrote in an abstract. “Further analysis on the availability of public access defibrillators at professional and recreational locations and availability of trained medical rescuers at the weekend vs. weekdays could account for the differences observed.” – by Scott Buzby
Reference:
Torney H, et al. Presentation 128. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Disclosures: Torney reports she is an employee of HeartSine Technologies.
Perspective
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Both in-hospital and out-of-hospital cardiac arrest victims appear to do worse during weekends. In-house patients are already under medical care and the first shock success for out-of-hospital patients is not related to day of the week. This tells me that even if defibrillation is adequate, the medical care after patients have arrested is less available or capable on weekends.
It is well known that hospitals employ less staff during weekends, which probably explains poorer results for in-house patients. For out-of-hospital patients, after resuscitation there may be less capable emergency staff to get them to the hospital. Alternatively, there may be fewer people to apply defibrillators on weekends, or the defibrillators may not be in proper areas for weekend events.
Studies are needed to delineate the deficiencies for cardiac arrest victims on weekends. If this involves staffing in hospitals, ambulances, placement of public defibrillators or training in use of equipment, these issues should be rectified.
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