World Journal of Emergency Medicine ›› 2026, Vol. 17 ›› Issue (2): 137-145.doi: 10.5847/wjem.j.1920-8642.2026.030
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Sohyeon Chun, Gi Woon Kim, Han Bit Kim(
)
Received:2025-06-15
Accepted:2025-10-10
Online:2026-03-17
Published:2026-03-01
Contact:
Han Bit Kim, Email: Hanbit6105@gmail.comSohyeon Chun, Gi Woon Kim, Han Bit Kim. Association between on-scene cardiopulmonary resuscitation duration and outcomes in out-of-hospital cardiac arrest patients[J]. World Journal of Emergency Medicine, 2026, 17(2): 137-145.
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URL: http://wjem.com.cn/EN/10.5847/wjem.j.1920-8642.2026.030
Figure 1.
Flowchart of this study. OHCA: out-of-hospital cardiac arrest. SALS: smart Advanced Life Support; DNR: do-not-resuscitate; CPR: cardiopulmonary resuscitation. Medical-cause cardiac arrest was defined as arrest due to presumed internal medical etiologies, whereas non-medical-cause cardiac arrest included arrests due to trauma, drowning, hanging, poisoning, asphyxia, burns, and other external causes.
Table 1.
Outcomes and characteristics of patients with and without prehospital ROSC
| Variables | Non-prehospital ROSC (n=12,516) | Prehospital ROSC (n=3,536) | P-value |
|---|---|---|---|
| Age, years, median (IQR) | 74 (60-82) | 63 (52-76) | <0.01 |
| Sex, male, n (%) | 7,893 (63.1) | 2,505 (70.8) | <0.01 |
| Arrest place at home, n (%) | 9,087 (73.8) | 2,246 (64.1) | <0.01 |
| Witnessed arrest, n (%) | 5,417 (43.3) | 2,309 (65.3) | <0.01 |
| Bystander CPR, n (%) | 7,775 (62.1) | 2,355 (66.6) | <0.01 |
| Shockable rhythm, n (%) | 1,462 (11.7) | 1,453 (40.6) | <0.01 |
| Response time interval, min, median (IQR) | 8 (6-10) | 7 (6-10) | <0.01 |
| Scene time interval, min, median (IQR) | 23 (18-28) | 21 (16-26) | <0.01 |
| Transport time interval, min, median (IQR) | 6 (4-9) | 7 (4-11) | <0.01 |
| Hospital procedure, n (%) | |||
| PCI | 148 (1.2) | 669 (18.9) | <0.01 |
| ECMO | 149 (1.2) | 111 (3.1) | <0.01 |
| TTM | 193 (1.5) | 675 (19.1) | <0.01 |
| Comorbidities, n (%) | |||
| Hypertension | 4,381 (35.0) | 1,016 (28.7) | <0.01 |
| Diabetes | 3,203 (25.6) | 683 (19.3) | <0.01 |
| Heart disease | 2,238 (17.9) | 674 (19.1) | 0.113 |
| Stroke | 1,153 (9.2) | 226 (6.4) | <0.01 |
| Cancer | 1,296 (10.4) | 233 (6.6) | <0.01 |
| Survival to admission, n (%) | 870 (7.0) | 2,315 (65.5) | <0.01 |
| Survival to discharge, n (%) | 231 (1.8) | 1,386 (39.2) | <0.01 |
| Good neurological outcome, n (%) | 42 (0.3) | 904 (25.6) | <0.01 |
Figure 2.
ROC curve and association between prehospital ROSC and on-scene CPR duration. A: the ROC curve illustrating the association between on-scene CPR duration and the likelihood of prehospital ROSC, with an AUROC value of 0.730 (95% CI, 0.708-0.752), indicating overall discrimination performance; B: the probability of achieving prehospital ROSC decreases from an initial 16% to below 10% as the on-scene CPR duration exceeds 20 min.
Figure 3.
Proportion of patients with good neurologic outcome (CPC 1-2) across scene time intervals from arrival. The proportion is calculated as (% = number of CPC 1-2 patients / total patients) within each scene time interval. As the scene time increases, the proportion of good neurologic outcome decreases, while poor neurologic outcome (CPC 3-5) becomes more prevalent.
Table 2.
Multivariate logistic analysis of factors associated with final ROSC, survival to discharge, and good neurological outcome in OHCA patients (n=12,842)
| Varibles | Odds ratio (95% confidence interval) | P-value |
|---|---|---|
| Final ROSC | ||
| Age | 0.981 (0.978-0.984) | <0.001 |
| Sex, male | 0.932 (0.853-1.018) | 0.116 |
| Witnessed | 2.092 (1.926-2.272) | <0.001 |
| Bystander CPR | 0.927 (0.852-1.009) | 0.078 |
| Shockable rhythm | 2.881 (2.596-3.196) | <0.001 |
| RTI | 0.938 (0.927-0.950) | <0.001 |
| STI | 0.963 (0.958-0.968) | <0.001 |
| TTI | 1.041 (1.033-1.048) | <0.001 |
| Diabetes | 0.982 (0.891-1.082) | 0.716 |
| Heart disease | 1.086 (0.977-1.207) | 0.125 |
| Survival to discharge | ||
| Age | 0.970 (0.966-0.974) | <0.001 |
| Sex | 1.132 (0.968-1.326) | 0.121 |
| Witnessed | 2.131 (1.847-2.462) | <0.001 |
| Bystander CPR | 1.092 (0.945-1.263) | 0.236 |
| Shockable rhythm | 6.816 (5.909-7.868) | <0.001 |
| RTI | 0.914 (0.894-0.933) | <0.001 |
| STI | 0.906 (0.897-0.915) | <0.001 |
| TTI | 1.033 (1.023-1.043) | <0.001 |
| Diabetes | 0.842 (0.706-1.002) | 0.056 |
| Heart disease | 1.235 (1.085-1.518) | 0.004 |
| Good neurological outcome | ||
| Age | 0.956 (0.950-0.962) | <0.001 |
| Sex | 1.591 (1.234-2.058) | <0.001 |
| Witnessed | 2.192 (1.772-2.722) | <0.001 |
| Bystander CPR | 1.180 (0.957-1.459) | 0.123 |
| Shockable rhythm | 17.516 (13.996-22.093) | <0.001 |
| RTI | 0.900 (0.873-0.927) | <0.001 |
| STI | 0.871 (0.859-0.884) | <0.001 |
| TTI | 1.035 (1.021-1.048) | <0.001 |
| Diabetes | 0.705 (0.535-0.922) | 0.012 |
| Heart disease | 1.559 (1.237-1.960) | <0.001 |
Figure 4.
Association between on-scene CPR variables and final ROSC, survival to discharge, and good neurological outcome. A-1 shows the ROC curve with an AUROC value of 0.697 (95% CI 0.676-0.717), indicating the model’s ability to discriminate outcomes associated with final ROSC. A-2 shows the scoring system for final ROSC, in which scene time interval (STI) was not retained as a contributing variable. B-1 displays the ROSC curve with an AUROC value of 0.836 (95% CI 0.810-0.861), representing the model’s ability to assess the association between input variables and survival to discharge. B-2 illustrates the score for STI is -1 per minute, indicating its effect on the probability of survival to discharge. C-1 presents the ROC curve with an AUROC value of 0.925 (95% CI 0.904-0.946), demonstrating the model’s strength in assessing the association with good neurological outcome. C-2 presents the score for STI is -1 per minute, showing its influence on achieving a good neurological outcome. RTI: response time interval; STI: scene time interval; TTI: transport time interval. Good neurological outcome was defined as CPC 1 or 2.
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