Title
The Influence of advanced life support response time on patient outcomes after out-of-hospital cardiac arrest in Taipei. 

Purpose of the study
Response time is a well known prognostic factor for patients with out-of-hospital cardiac arrest (OHCA). However, the association between OHCA patient survival and advanced life support (ALS) response time remained controversial. We tested the hypothesis that for adult, non-trauma OHCA patient, shorter ALS response time was associated with better chance of survival. 

Materials and methods
We analyzed Utstein-based registry data on OHCA patients in Taipei form 2011 to 2015. The eligible patients were adult, aged ≧20 years, with non-traumatic OHICA who underwent resuscitation attempts participated by ALS team. Patients without complete data, witnessed by emergency medical technicians, or response time ≧15 minutes were exclude. The exposure was ALS response time. The primary outcome was survival to discharge, and the secondary outcome is the favorable neurological outcome (cerebral performance category ≦ 2). Subgroup analyses were based on presenting rhythms of OHCA, including shockable, pulseless electrical activity (PEA) and asystole.

Results
A total of 4,278 cases were included in final analysis. The median ALS response time was 9 minutes (interquartile range 7 to 12). Every minute delay of any ALS response time would reduce 7% chance of survival to discharge (adjusted odds ratio [aOR] 0.93; 95% confidence interval [CI]: 0.90-0.97) as well as favorable neurological outcome (aOR 0.91; 95%CI: 0.86-0.97). Subgroup analysis showed the longer ALS response time was negatively associated with the chances of survival to discharge among OHCA patients with shockable rhythm (aOR 0.89; 95%CI: 0.83-0.95) and PEA group (aOR 0.92; 95%CI: 0.86-0.99).

Conclusions
In non-trauma adult OHCA in Taipei, the longer ALS response time was associated with the worse odds of survival to discharge and favorable neurologic outcome, especially in patients with presenting shockable rhythm and PEA group.

6 - The Influence of advanced life support response time on patient outcomes after out-of-hospital cardiac arrest in Taipei.