When Time is of the Essence: Comparison of the Resuscitation Time Frame Recommended by the Advanced Life Support Guidelines and Daily Practice

Abstract Objective: Advanced Life Support (ALS) providers are guided through several time-specific critical actions during Cardiac Arrest (CA) by universally adopted guidelines. The objective of this study was to evaluate whether the advised timings of these critical interventions are met in practice. Subject and methods: This single centre, prospective observational study analyzed data derived from Out-Of-Hospital Cardiac Arrest (OHCA) video recordings by a team member. Real life timings of critical actions were compared to recommendations. Results and conclusion: The first dose of epinephrine was administered at a median time of 3 min 10s in the non-shockable patient group and 3 min 27s in the shockable group. In 27.8% of all non-shockable OHCAs, epinephrine was administered in the first cycle. Placement of an Advanced Airway (AA) took place in the advised cycle in less than 20% of cases. Initial endotracheal intubation success rate was 69.5%. In 20.3% of the resuscitations, more than two attempts were needed for endotracheal intubation. Medical mobile teams failed in starting treatment on time, taking up to twice the recommended time. The first shock was administered at a median time of 25.5s after the first rhythm check. The second and third shock were administered after respectively 3 min 44s, and 5 min 21s, respectively. With more than 75% of all OHCA deviating from the guidelines, it is necessary to make prehospital healthcare workers aware of time loss during critical actions. Training in a time-sensitive manner might help increase awareness and optimize daily practice.