Duration of cardiopulmonary resuscitation in patients without prehospital return of spontaneous circulation after out-of-hospital cardiac arrest: Results from a severity stratification analysis

Resuscitation. 2018 Mar:124:69-75. doi: 10.1016/j.resuscitation.2018.01.008. Epub 2018 Jan 6.

Abstract

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.

Keywords: Cardiopulmonary resuscitation; Epidemiology; Out-of-hospital cardiac arrest.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Resuscitation* / methods
  • Cardiopulmonary Resuscitation* / mortality
  • Electric Countershock / methods
  • Electric Countershock / mortality
  • Emergency Medical Services / methods
  • Female
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / classification
  • Out-of-Hospital Cardiac Arrest / mortality*
  • Outcome Assessment, Health Care
  • Population Surveillance
  • Prospective Studies
  • Registries
  • Time Factors*