Time perception in the management of out-of-hospital cardiac arrest

Objective Time management is a critical aspect in the treatment of out-of-hospital cardiac arrest (OHCA). The American Heart Association guidelines provide specific time frames for critical actions while recommending minimal interruption in chest compression. A variety of factors can alter time perception, but there is limited and conflicting evidence regarding prehospital performance. This study aimed to assess emergency medical services (EMS) personnel's perception of time and performance during the management of OHCA. Methods A retrospective observational study was performed utilizing data obtained from the quality improvement database of a fire-based EMS agency that responds to approximately 10,000 calls for service annually. Data collected over a period of 6 months were reviewed and compared with the actual cardiac monitor data obtained during resuscitation. The primary outcome was the difference between perceived versus actual performance. Results A total of 33 OHCA cases were identified. Twelve cases were excluded due to incomplete data, leaving a final sample size of 21 OHCA cases for analysis. EMS personnel significantly underestimated the length of the longest pause in chest compressions (19.98 seconds vs. 31.99 seconds: 95% confidence interval [CI], 2.62 to 21.43; P=0.013) and significantly underestimated the interval between the initiation of chest compressions and administration of the first dose of epinephrine (274.65 seconds vs. 356.43 seconds: 95% CI, 1.71 to 161.85; P=0.045). No significant difference was found in perceptions of the overall compression fraction (84.4% vs. 87.2%: 95% CI, –5.57 to 3.16; P=0.586). Conclusion Our results suggest that EMS personnel underestimate critical time intervals during the treatment of OHCA.