Emergency Medical Services Equipment Use in the Emergency Department and Time to Care for Those With Out-of-Hospital Cardiac Arrest

STUDY HYPOTHESIS: Early defibrillation is crucial in improving out-of-hospital cardiac arrest (OHCA) survival. The use of emergency medical services (EMS) equipment is associated with shorter time to first emergency department (ED) rhythm analysis/defibrillation. METHODS: This is a single-center, retrospective, video review-based study conducted between October 2018 and February 2024. It includes video-recorded patients with OHCA aged 18 and older and excludes patients with traumatic arrests and out-of-hospital return of spontaneous circulation (ROSC). Groups were based on EMS versus ED monitors/defibrillators/pads use for initial ED rhythm analysis. The primary and secondary outcomes were time to first ED rhythm analysis and time to first ED defibrillation, respectively. The exploratory outcomes were time of ED bed transfer, rates of ROSC, survival to hospital admission/discharge, and neurologic outcome. RESULTS: Of 223 OHCA patients included, 75 (33.6%) were grouped into EMS and 148 (66.4%) into ED. Out-of-hospital shockable rhythms were reported in 26.5% of EMS and 10.5% of ED groups. The EMS group had a shorter median time to first ED rhythm analysis (143-second difference, 95% confidence interval [CI] 116 to 169) and first ED defibrillation (131.5-second difference, 95% CI 8 to 272). In exploratory analysis, the EMS group had longer time to ED bed transfer (15.0-second difference, 95% CI 0 to 21) and more frequent defibrillation in the ED (18.0% difference, 95% CI 4.2 to 31.8). Forty-four patients survived to hospital admission and 8 survived to hospital discharge. CONCLUSION: Initial ED rhythm analysis using EMS equipment may be associated with shorter time to initial rhythm analysis.