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Circulation. 2013 Dec 17;128(24):2595-602. doi: 10.1161/CIRCULATIONAHA.113.004164. Epub 2013 Sep 17.

Temporal differences in out-of-hospital cardiac arrest incidence and survival.

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From St. Michael's Hospital, University of Toronto, Ontario, Canada (A.B.); Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA (B.F.M.); Duke Clinical Research Institute, Durham, NC (S.M.A.-K., S.K., E.L.F., L.M., C.B.G., J.G.J.); Wake County Department of Emergency Medical Services, Raleigh, NC (J.B.M.); Department of Cardiology, University Hospital Gentofte, Gentofte, Denmark (L.K., M.W.); Institute of Health, Science and Technology, Aolborg University, Aolborg, Denmark (C.T.-P.); Division of Critical Care and Cardiology, University of Alberta, Alberta, Ontario, Canada (S.v.D.); and Center for Resuscitation Science, University of Pennsylvania, Philadelphia (B.S.A.).



Understanding temporal differences in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) has important implications for developing preventative strategies and optimizing systems for OHCA care.


We studied 18 588 OHCAs of presumed cardiac origin in patients aged ≥18 years who received resuscitative efforts by emergency medical services (EMS) and were enrolled in the Cardiac Arrest Registry to Enhance Survival (CARES) from October 1, 2005, to December 31, 2010. We evaluated temporal variability in OHCA incidence and survival to hospital discharge. There was significant variability in the frequency of OHCA by hour of the day (P<0.001), day of the week (P<0.001), and month of the year (P<0.001), with the highest incidence occurring during the daytime, from Friday to Monday, in December. Survival to hospital discharge was lowest for OHCA that occurred overnight (from 11:01 pm to 7 am; 7.1%) versus daytime (7:01 am to 3 pm; 10.8%) or evening (3:01 pm to 11 pm; 11.3%; P<0.001) and during the winter (8.8%) versus spring (11.1%), summer (11.0%), or fall (10.0%; P<0.001). There was no difference in survival to hospital discharge between OHCAs that occurred on weekends and weekdays (9.5% versus 10.4%, P=0.06). After multivariable adjustment for age, sex, race, witness status, layperson resuscitation, first monitored cardiac rhythm, and emergency medical services response time, compared with daytime and spring, survival to hospital discharge remained lowest for OHCA that occurred overnight (odds ratio, 0.81; 95% confidence interval, 0.70-0.95; P=0.008) and during the winter (odds ratio, 0.81; 95% confidence interval, 0.70-0.94; P=0.006), respectively.


There is significant temporal variability in the incidence of and survival after OHCA. The relative contribution of patient pathophysiology, likelihood of the OHCA being observed, and prehospital and hospital-based resuscitative factors deserves further exploration.


epidemiology; heart arrest; mortality; out-of-hospital cardiac arrest

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