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Crit Care. 2016 May 10;20(1):141. doi: 10.1186/s13054-016-1323-4.

Nighttime is associated with decreased survival and resuscitation efforts for out-of-hospital cardiac arrests: a prospective observational study.

Author information

1
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan.
2
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan. taka.nakada@nifty.com.
3
Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-0022, Japan.
4
Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-0033, Japan.
5
National Cerebral and Cardiovascular Center Hospital, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
6
Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-0032, Japan.
7
Department of Biostatistics, Kyoto University School of Public Health, Kyoto, 606-8501, Japan.
8
Nihon University Surugadai Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
9
Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan.
10
Department of Emergency Medicine, Yokohama City University Medical Center, 4 -57 Urafunecho, Minami-ku, Yokohama City, Kanagawa, 232-0024, Japan.

Abstract

BACKGROUND:

Whether temporal differences alter the clinical outcomes of patients with out-of-hospital cardiac arrest (OHCA) remains inconclusive. Furthermore, the relationship between time of day and resuscitation efforts is unknown.

METHODS:

We studied adult OHCA patients in the Survey of Survivors after Out-of-Hospital Cardiac Arrest in the Kanto Region (SOS-KANTO) 2012 study from January 2012 to March 2013 in Japan. The primary variable was 1-month survival. The secondary outcome variables were prehospital and in-hospital resuscitation efforts by bystanders, emergency medical services personnel, and in-hospital healthcare providers. Daytime was defined as 0701 to 1500 h, evening was defined as 1501 to 2300 h, and night was defined as 2301 to 0700 h.

RESULTS:

During the study period, 13,780 patients were included in the analysis. The patients with night OHCA had significantly lower 1-month survival compared to the patients with daytime OHCA (night vs. daytime, adjusted odds ratio (OR) 1.66; 95 % confidence interval (CI), 1.34-2.07; P < 0.0001). The nighttime OHCA patients had significantly shorter call-response intervals, bystander CPR, in-hospital intubation, and in-hospital blood gas analyses compared to the daytime and evening OHCA patients (call-response interval: OR 0.95 and 95 % CI 0.93-0.96; bystander CPR: OR 0.85 and 95 % CI 0.78-0.93; in-hospital intubation: OR 0.85 and 95 % CI 0.74-0.97; and in-hospital blood gas analysis: OR 0.86 and 95 % CI 0.75-0.98).

CONCLUSIONS:

There was a significant temporal difference in 1-month survival after OHCA. The nighttime OHCA patients had significantly decreased resuscitation efforts by bystanders and in-hospital healthcare providers compared to those with evening and daytime OHCA.

KEYWORDS:

Cardiopulmonary resuscitation; Circadian rhythm; Heart arrest; Out-of-hospital cardiac arrest; Resuscitation

PMID:
27160587
PMCID:
PMC4862118
DOI:
10.1186/s13054-016-1323-4
[Indexed for MEDLINE]
Free PMC Article

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