Abstract
The impact of pre- versus post-arrest emergency calls from care facilities on out-of-hospital cardiac arrest (OHCA) outcomes remains unclear. This study examined how call timing and time of day influence bystander cardiopulmonary resuscitation (BCPR) and 1-month survival. We conducted a nationwide retrospective cohort study from 2017 to 2022. We analyzed 27,222 witnessed OHCAs of presumed cardiac origin in adults aged ≥ 65 years in care facilities. Pre-arrest calls were defined as cases in which the witnessed time occurred after the EMS call time; post-arrest calls were those in which the witnessed time was the same as or earlier than the call time. The primary outcome was 1-month survival and the secondary was BCPR rate. Propensity score matching and logistic regression were used for survival analysis. Of all cases, 10,789 (39.6%) were preceded by pre-arrest calls. BCPR was less frequent in pre-arrest than post-arrest cases (43.3% vs. 84.4%; p < 0.01). Survival was highest during daytime (8.0%) and lowest at night (3.3%). Nighttime occurrence (adjusted odds ratio = 0.45, confidence interval = 0.40–0.51) and pre-arrest calls (0.78, 0.68–0.89) independently predicted lower survival. Early EMS activation alone is insufficient. Continuous dispatcher guidance and improved night-shift preparedness in care facilities may enhance OHCA outcomes.
Data availability
The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
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Acknowledgements
We acknowledge the Fire and Disaster Management Agency of Japan for providing access to the national EMS database used in this study.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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GT and YT had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: YT. Data acquisition: GT and YT. Analysis and interpretation of data: All authors. Drafting of the manuscript: GT and YT. Statistical analysis: GT and YT. Study supervision: YT. All authors read and approved the final manuscript.GT and YT contributed equally to this work as co-first authors.
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Toyama, G., Takei, Y., Omatsu, K. et al. Impact of EMS call timing on bystander CPR and survival after cardiac arrest in care facilities. Sci Rep (2026). https://doi.org/10.1038/s41598-026-39110-5
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DOI: https://doi.org/10.1038/s41598-026-39110-5
