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Resuscitation. 2014 Nov;85(11):1623-8. doi: 10.1016/j.resuscitation.2014.07.010. Epub 2014 Aug 12.

The effect of time to defibrillation and targeted temperature management on functional survival after out-of-hospital cardiac arrest.

Author information

1
Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Department of Medicine, University of Toronto, Toronto, ON, Canada; School of Health and Wellness, Georgian College, Barrie, ON, Canada. Electronic address: DrennanI@smh.ca.
2
Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: LinS@smh.ca.
3
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: Kevin.Thorpe@utoronto.ca.
4
Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: MorrisonL@smh.ca.

Abstract

BACKGROUND:

Cardiac arrest physiology has been proposed to occur in three distinct phases: electrical, circulatory and metabolic. There is limited research evaluating the relationship of the 3-phase model of cardiac arrest to functional survival at hospital discharge. Furthermore, the effect of post-cardiac arrest targeted temperature management (TTM) on functional survival during each phase is unknown.

OBJECTIVE:

To determine the effect of TTM on the relationship between the time of initial defibrillation during each phase of cardiac arrest and functional survival at hospital discharge.

METHODS:

This was a retrospective observational study of consecutive adult (≥18 years) out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythms. Included patients obtained a return of spontaneous circulation (ROSC) and were eligible for TTM. Multivariable logistic regression was used to determine predictors of functional survival at hospital discharge.

RESULTS:

There were 20,165 OHCA treated by EMS and 871 patients were eligible for TTM. Of these patients, 622 (71.4%) survived to hospital discharge and 487 (55.9%) had good functional survival. Good functional survival was associated with younger age (OR 0.94; 95% CI 0.93-0.95), shorter times from collapse to initial defibrillation (OR 0.73; 95% CI 0.65-0.82), and use of post-cardiac arrest TTM (OR 1.49; 95% CI 1.07-2.30). Functional survival decreased during each phase of the model (65.3% vs. 61.7% vs. 50.2%, P<0.001).

CONCLUSION:

Functional survival at hospital discharge was associated with shorter times to initial defibrillation and was decreased during each successive phase of the 3-phase model. Post-cardiac arrest TTM was associated with improved functional survival.

KEYWORDS:

Neurological outcome; Out-of-hospital cardiac arrest; Post-cardiac arrest care; Targeted temperature management

[Indexed for MEDLINE]

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