{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T03:47:25Z","timestamp":1794023245241,"version":"4.8.0"},"reference-count":38,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Out-of-hospital cardiac arrest (OHCA) remains a major public health concern, characterized by high mortality and substantial variability in survival rates. As patient and event characteristics are largely unmodifiable, system efficiency is essential to improve survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using data from the Lombardia Cardiac Arrest Registry, including 12 532 OHCA cases (2015\u20132023). Multivariate logistic regression models were applied to assess the relationship between emergency medical service (EMS) arrival time and prehospital mortality, as well as long-term outcomes according to system efficiency. Furthermore, a sub-cohort of 515 hospitalized patients was analysed to evaluate hospital stay and healthcare costs. Prehospital event mortality increased from 74.7 to 93.2% with longer EMS response time, with survival decreasing by 0.6% for each additional minute of EMS delay (OR 1.03; 95% CI 1.02\u20131.05). Higher system efficiency, characterized by bystander cardiopulmonary resuscitation and EMS arrival within 10\u2005min, was associated with markedly higher survival at hospital admission (25.4% vs. 7.6%) and at 12 months (13.0% vs. 1.6%), as well as improved neurological outcomes and discharge survival among hospitalized patients. Higher hospital costs were observed among patients in the high-efficiency system group, while less efficient systems showed higher costs per survivor at 12 months follow-up (\u20ac61 781 vs. \u20ac48 985).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>System responsiveness is a key modifiable factor influencing outcomes after OHCA, with each minute of EMS delay substantially reducing survival odds. Enhancing the entire chain of survival is essential to improve patient outcomes and reduce the indirect societal costs associated with OHCA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcag121","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T11:32:39Z","timestamp":1785065559000},"source":"Crossref","is-referenced-by-count":2,"title":["Impact of system efficiency on out-of-hospital cardiac arrest outcomes and hospital stay: an observational study from Lombardia CARe"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0789-724X","authenticated-orcid":false,"given":"Corina","family":"Marjin","sequence":"first","affiliation":[{"name":"Department of Public Health, Experimental and Forensic Medicine, University of Pavia , Via Forlanini 2, Pavia 27100 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IRCCS Policlinico San Matteo , Viale Camillo Golgi 19, Pavia 27100 ,","place":["Italy"]},{"name":"National PhD Programme in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine, University of Pavia , Pavia, 27100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Primi","sequence":"additional","affiliation":[{"name":"Department of Public Health, Experimental and Forensic Medicine, University of Pavia , Via Forlanini 2, Pavia 27100 ,","place":["Italy"]},{"name":"Division of Cardiology, Fondazione IRCCS Policlinico San Matteo , Viale Camillo Golgi 19, Pavia 27100 ,","place":["Italy"]},{"name":"Cardiac Arrest and Resuscitation Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo , Viale Camillo Golgi 19, Pavia 27100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3676-7169","authenticated-orcid":false,"given":"Alessia","family":"Currao","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Fondazione IRCCS Policlinico San Matteo , Viale Camillo Golgi 19, Pavia 27100 ,","place":["Italy"]},{"name":"Cardiac Arrest and Resuscitation Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo , Viale Camillo Golgi 19, Pavia 27100 ,","place":["Italy"]},{"name":"Department of Internal Medicine and Medical Therapy, University of Pavia , Campus della Salute, Viale Camillo Golgi 19, Pavia 27100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Bendotti","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Fondazione IRCCS Policlinico San Matteo , Viale Camillo Golgi 19, Pavia 27100 ,","place":["Italy"]},{"name":"Cardiac Arrest and Resuscitation Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo , Viale Camillo Golgi 19, Pavia 27100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6360-224X","authenticated-orcid":false,"given":"Enrico","family":"Baldi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Fondazione IRCCS Policlinico San Matteo , Viale Camillo Golgi 19, Pavia 27100 ,","place":["Italy"]},{"name":"Cardiac Arrest and Resuscitation Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo , Viale Camillo Golgi 19, Pavia 27100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Migliari","sequence":"additional","affiliation":[{"name":"Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ) , Via Alfredo Campanini 6, Milan 20124 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