Journal
RESUSCITATION
Volume 124, Issue -, Pages 69-75Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.resuscitation.2018.01.008
Keywords
Out-of-hospital cardiac arrest; Cardiopulmonary resuscitation; Epidemiology
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Funding
- JSPS KAKENHI [JP16K19171]
- Grants-in-Aid for Scientific Research [16K19171] Funding Source: KAKEN
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Background: The relationship between duration of cardiopulmonary resuscitation (CPR) and post-arrest outcomes based on severity stratification in out-of-hospital cardiac arrest (OHCA) patients without prehospital return of spontaneous circulation (ROSC) remains unclear. Methods: We analysed 420,959 adult patients without prehospital ROSC in the All-Japan OHCA registry for 4 years. Prehospital CPR duration was defined as the time from CPR initiation by emergency medical service (EMS) providers to hospital arrival. The primary outcome was 1-month neurologically intact survival (cerebral performance category 1 or 2, CPC 1-2). Results: The rate of overall 1-month CPC 1-2 was 0.45% (1899/420,959). Using recursive partitioning analysis to predict 1-month CPC 1-2, we stratified patients into 4 groups with 3 predictors: patients aged < 75 years with initial shockable rhythm (1-month CPC 1-2 rate, 6.15%), those aged >= 75 years with initial shockable rhythm (1.32%), those with EMS-witnessed arrest and initial non-shockable rhythm (1.62%), and those with EMS-unwitnessed arrest and initial non-shockable rhythm (0.15%). Prehospital CPR duration was negatively associated with 1-month CPC 1-2 (adjusted odds ratio 0.94 per 1-min increment; 95% confidence interval 0.94-0.95). Prehospital CPR durations beyond which the dynamic probability of 1-month CPC 1-2 decreased to < 1% were 26 min, 10 min, 7 min, and at all times in above-mentioned stratification, respectively. Conclusions: In OHCA patients without prehospital ROSC, those aged < 75 years with initial shockable rhythm had acceptable 1-month CPC 1-2 rate. However, CPR efforts lasting 26 min or over before hospital arrival could be futile. (c) 2018 Elsevier B.V. All rights reserved.
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