Abstract P199: Relationship Between Favorable Neurological Outcomes And Time Interval From Collapse To ROSC In Patients Treated With Hypothermia: A Multicenter Study; J-PULSE-Hypo registry
Background Clinical evidence strongly supported mild hypothermia as an effective therapy for patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest, but the patients who may benefit from this treatment have not been fully elucidated. We investigated the relationship between neurological benefits and time interval from collapse to ROSC.
Methods We did a multicenter observational study of therapeutic hypothermia for unconscious adult patients with ROSC after out-of-hospital cardiac arrest. The committee entrusted each hospital with timing of cooling, cooling methods, target temperature, duration, and rewarming rate. The primary endpoint was a favorable neurological outcome at 30 days survival.
Results A total of 281 patients were enrolled in this study. Of those, a favorable neurological outcome was seen in 157(55.9%). A median (IQR) collapse-to-ROSC interval was 25 (17–40) min, and the collapse-to-ROSC interval of patients with favorable neurological outcome was shorter than that with unfavorable neurological outcome (median; 18 min vs. 34 min, p<0.0001). The collapse-to-ROSC interval cutoff value of 25.5 min had an accuracy of 76.0% for identification of a favorable neurological outcome. In addition, a collapse-to-ROSC interval of 65.5 min had a negative predictive of 100% for a favorable neurological outcome. In the multiple logistic-regression analysis, a collapse-to-ROSC interval cutoff value of 25.5 min was an strong independent predictor of a favorable neurological outcome(adjusted odds ratio, 9.3, 95%CI; 4.8–17.9, p<0.0001).
Conclusions In patients undergoing mild hypothermia after ROSC, time interval from collapse to ROSC was an independent predictor for a favorable neurological outcome. Further research is needed in patients with prolonged CPR of 25 min or longer.