Photo Credit: Chalabala
The following is a summary of “Association between EMS response times, low socioeconomic status, and poorer outcomes in out-of-hospital cardiac arrest: the MEDIC multicenter retrospective cohort study for disparities in access to prehospital critical care in the Paris metropolitan area,” published in the August 2024 issue of Emergency Medicine by Heidet et al.
Longer emergency medical services response times (EMS-RT) and delayed patient access time intervals (PATI), especially in areas with low socioeconomic status (SES), are linked to worse outcomes after out-of-hospital cardiac arrest (OHCA).
Researchers conducted a retrospective study to identify predictors of prolonged EMS-RT intervals and to assess association with clinical outcomes in OHCAs within France’s largest metropolitan area.
They measured the EMS-RT from activation to patient arrival. Secondary outcomes included dispatch-to-patient contact interval (EMS-RT), vehicle scene arrival-to-PATI, and patient outcomes at 30 days, death, and unfavorable neurological status. The SES was evaluated using the European Deprivation Index (EDI) at the census tract level, categorized into quintiles (Q5 = most deprived). Multilevel mixed-effects regression models were used to analyze predictors of patient access outcomes and their link to clinical results.
The results showed 4,082 cases; the median EMS-RT was 10.85 minutes (IQR [8.87–13.15]), with 138 patients (3.4%) surviving hospital discharge. Independent factors increasing EMS-RT and vehicle scene arrival-to-PATI included age over 65, female sex, elevated floor location, unwitnessed arrests, and low EDI (all P<0.018). Multivariable analysis revealed that an EMS-RT greater than 8 minutes was linked to higher mortality and worse neurological outcomes at discharge (both P<0.001).
Investigators concluded that longer EMS delays until patient contact were observed in low SES neighborhoods of the Greater Paris metropolitan area, associated with worse OHCA outcomes after adjusting for scene factors.
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