• Jacob Hutton, Joseph H Puyat, Michael Asamoah-Boaheng, Boris Sobolev, Saud Lingawi, Mahsa Khalili, Calvin Kuo, Babak Shadgan, Jim Christenson, and Brian Grunau.
• Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, Canada; British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, University of British Columbia, British Columbia, Canada. Electronic address: Jacob.hutton@ubc.ca.
• Resuscitation. 2023 Sep 1; 190: 109906109906.

BackgroundBiosensor technologies have been proposed as a solution to provide recognition and facilitate earlier responses to unwitnessed out-of-hospital cardiac arrest (OHCA) cases. We sought to estimate the effect of recognition on survival and modelled the potential incremental impact of increased recognition of unwitnessed cases on survival to hospital discharge, to demonstrate the potential benefit of biosensor technologies.MethodsWe included cases from the British Columbia Cardiac Arrest Registry (2019-2020), which includes Emergency Medical Services (EMS)-assessed OHCAs. We excluded cases that would not have benefitted from early recognition (EMS-witnessed, terminal illness, or do-not-resuscitate). Using a mediation analysis, we estimated the relative benefits on survival of a witness recognizing vs. intervening in an OHCA; and estimated the expected additional number of survivors resulting from increasing recognition alone using a bootstrap logistic regression framework.ResultsOf 13,655 EMS-assessed cases, 11,412 were included (6314 EMS-treated, 5098 EMS-untreated). Survival to hospital discharge was 191/8879 (2.2%) in unwitnessed cases and 429/2533 (17%) in bystander-witnessed cases. Of the total effect attributable to a bystander witness, recognition accounted for 84% (95% CI: 72, 86) of the benefit. If all previously unwitnessed cases had been bystander witnessed, we would expect 1198 additional survivors. If these cases had been recognized, but no interventions performed, we would expect 912 additional survivors.ConclusionUnwitnessed OHCA account for the majority of OHCAs, yet survival is dismal. Methods to improve recognition, such as with biosensor technologies, may lead to substantial improvements in overall survival.Copyright © 2023 Elsevier B.V. All rights reserved.

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