Karlsson, Lena I. M.4; Wissenberg Jørgensen, Mads3; Fosbøl, Emil L.4; Hansen, Carolina Malta4; Lippert, Freddy K.4; Bagai, Akshay4; McNally, Bryan4; Granger, Christopher B.4; Christensen, Erika Frischknecht4; Folke, Fredrik4; Rajan, Shahzleen4; Weeke, Peter4; Nielsen, Søren L.4; Køber, Lars4; Gislason, Gunnar H.4; Torp-Pedersen, Christian1
1 Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, VBN2 Public Health and Epidemiology Group, The Faculty of Medicine, Aalborg University, VBN3 The Faculty of Medicine, Aalborg University, VBN4 unknown
a nationwide study in Denmark
AIM: To investigate diurnal variations in incidence and outcomes following out-of-hospital cardiac arrest (OHCA). METHODS: OHCA of presumed cardiac etiology were identified through the nationwide Danish Cardiac Arrest Registry (2001-2010). Time of day was divided into three time periods: daytime 07.00-14.59; evening 15.00-22.59; and nighttime 23.00-06.59. RESULTS: We identified 18,929 OHCA patients, aged ≥18 years. The median age was 72 years (IQR 62-80) and the majority were male (67.5%). OHCA occurrence varied across time periods, with 43.9%, 35.7% and 20.6% occurring during daytime, evening and nighttime, respectively. Nighttime patients were more likely to have: severe comorbidity (i.e. COPD), arrest in private home (87.2% vs. 69.0% and 73.0% daytime and evening, respectively), non-witnessed arrest (51.2% vs. 48.4% and 43.7%), no bystander CPR (75.9% vs. 68.4% and 66.1%), longer time interval from recognition of OHCA to rhythm analysis (12 min vs. 11 min and 11 min), and non-shockable heart rhythm (80.1% vs. 70.3% and 69.4%), all p<0.0001. Nighttime patients were less likely to achieve return of spontaneous circulation on arrival at the hospital (7.5% vs. 14.8% and 15.1%) and 1-year survival (2.8% vs. 7.2% and 7.1%), p<0.0001. Overall, the lower 1-year survival rate persisted after adjusting for patient-related and cardiac-arrest related characteristics mentioned above (OR 0.47, 95%CI 0.37-0.59; OR 0.51, 95%CI 0.40-0.65, compared to daytime and evening, respectively). CONCLUSIONS: We found nighttime patients to have a lower survival compared to daytime and evening that persisted when adjusting for patient-related and cardiac-arrest related characteristics including comorbidities.
Resuscitation, 2014, Vol 85, Issue 9, p. 1161-1168