Influence of demographic parameters and time delays among patients with ACS and OHCA in non-urban areas

Abstract

Introduction Out-of-hospital cardiac arrest (OHCA) represents a major public health. Acute coronary syndrome (ACS) is the leading precipitant of collapse. Predictors of survival have been described in the literature. However, most studies have been conducted in city areas. Less is known about resuscitation performance of mobile medical team (MMT) in non-urban areas. Established in 1903, our institution was initially founded to treat patients suffering from tuberculosis. Built at the top of a hill, the location of the ancient sanatorium consists of rural areas with a low population density. Objectives To perform a quality control assessment on the management of OHCA after ACS in non-urban areas. To identify quantitative variables influencing 30-day outcome. Methods Retrospective single-center study including 40 patients resuscitated from OHCA after ACS. Baseline characteristics, resuscitation settings, time delays, blood samples, cardiac findings and clinical outcomes were analyzed. Results 30-day mortality was more likely associated with the following parameters: age, no-bystander CPR, no use of AED, non-convertible rhythm, recurrent cardiac arrest, epinephrine dose, shock, lactate level,\xa0LVEF, culprit lesion, no-flow & low-flow\xa0duration, kilometres and time delays (MMT arrival, ER - CathLab - ICU admission). Particularly, high lactate, long duration of RCP, remoteness from hospital and prolonged pre-hospital management (MMT arrival, ER admission) were predictors of early mortality (see bold type in Table 1 ). Conclusion Beyond the usual prognostic factors, it would appear that demographic parameters and time delays represent major determinants of mortality after OHCA in non-urban areas. Therefore, shortening response times and prompt delivery to hospital facilities may help to improve the prognosis, rather than prolonged pre-hospital care. Further RCTs are needed to assess the effect of the ‘scoop\xa0& run’ approach vs the ‘stay\xa0& play’ approach in this setting.