Clinical paper Out of hospital cardiac arrest outcomes: Impact of weekdays vs weekends admission on survival to hospital discharge Alain El Asmar a , Alik Dakessian a , Rana Bachir a , Mazen El Sayed a, b, * a Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon b Emergency Medical Services and Pre-hospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon Abstract Background: Cardiac arrests are a leading cause of mortality with survival of only 12%. In the United States, cardiac arrests were significantly more likely to occur on Saturdays. Hospitals experience a decrease in staffing on weekends. This study aims to assess the relationship between weekend vs weekday admission and outcomes of patients presenting with out of hospital cardiac arrests (OHCA) in the United States. Methods: This retrospective study utilized the 2014 US National Emergency Department Sample (NEDS) database. Patients who sustained out of hospital cardiac arrests were included using ICD-9-CM codes. Descriptive analysis was conducted, followed by bivariate analysis to compare the collected variables by admission day. Multivariate analysis was done to assess the impact of weekday vs weekend admission on survival of cardiac arrests patients after adjusting for confounders. Results: A total of 145,774 patients with cardiac arrest were included in this study. Mean age was 65.9 years with male predominance of 61.8%. Almost 71% of cardiac arrests took place on a weekday. As an overall outcome, only 5.7% patients survived to hospital discharge. After adjusting for significant confounders, patients presenting on weekends were less likely to survive compared to those admitted on weekdays (OR = 0.833, 95% CI: 0.727 –0.954). Conclusion: In this study, patients with OHCA admitted to the ED on weekends had slightly lower survival compared to those admitted on weekdays. Modifiable factors should be identified in future studies to reduce outcome discrepancies and improve survival in this patient population. Keywords: Out of hospital cardiac arrest, Weekend, Weekday, Survival, Outcome Introduction Cardiac arrest is a leading cause of mortality in the United States affecting over 350,000 persons per year, with an overall reported survival of only 12%. 1 Previously reported poor predictors of outcomes include older age, longer time from collapse to Cardiopul- monary Resuscitation (CPR), and from collapse to the first defibrilla- tion. 2 On the other hand, factors that lead to better outcomes and increased survival include witnessed cardiac arrests, in addition to ventricular fibrillation or tachycardia as initial cardiac rhythms. 3 The difference in frequencies of out of hospital cardiac arrest (OHCA) by day of the week has been previously examined. In the United States, cardiac arrests were significantly more likely to occur on Saturdays. 4 This is important since hospitals tend to experience a decrease in staffing on weekends and holidays compared to weekdays which usually affects regular floors, intensive care units, operating rooms and emergency departments. Differences in patient outcomes when comparing weekdays to weekends have also been previously described in the literature for specific diagnoses. In older studies out of Canada, higher in-hospital mortality was found in patients admitted on weekends with specific * Corresponding author at: Department of Emergency Medicine, American University of Beirut Medical Center, P.O. Box - 11-0236 Riad El Solh, Beirut, Lebanon. E-mail address: melsayed@aub.edu.lb (M. El Sayed). https://doi.org/10.1016/j.resuscitation.2019.08.004 Received 22 May 2019; Received in revised form 25 July 2019; Accepted 2 August 2019 0300-9572/© 2019 Elsevier B.V. All rights reserved. R E S U S C I T A T I O N 1 4 3 ( 2 0 1 9 ) 2 9 – 3 4 Available online at www.sciencedirect.com Resuscitation jo u rn al h om ep age: w ww .elsevier .co m /loc ate/r esu s cit atio n