Abstract 103: Does the Duration of Transportation Influence Neurological Outcome of Victims with Out-of-Hospital Cardiac Arrest?
[Background and Goal] The 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommend that resuscitated patients from out-of-hospital cardiac arrest (OHCA) should be transported by emergency medical service (EMS) to the certain hospital which can do intensive care including therapeutic hypothermia and emergency cardiac catheterization. But it might be more time consuming and could be more harmful for those patients. To clarify whether long transportation time (TT) influence neurological outcome of patients with OHCA, we examined the relationship between the duration of transportation and good neurological survival (GNS) which was defined as the Glasgow-Pittsburgh cerebral performance category (CPC) of 1 or 2 after one month of OHCA.
[Methods and Results] From January 1, 2005, through December 31, 2010, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA (n=670,314). Out of all OHCA cases, we analyzed patients with bystander witnessed, EMS treated, cardiogenic arrest, and with initial arrest rhythm of ventricular fibrillation or tachycardia (VT/VF) (n=26,762), or asystole or pulseless electrical activity (Asys/PEA) (n=89,629). The duration from witness to arrival at the hospital was calculated as TT. Results were shown in the figure. In cases with VF/VT, GNS was decreased linearly from more than 30% to 15% until 30 minutes of TT, then showed plateau of around 15% until 60 minutes. On the other hand, GNS was less than 3% even when TT was very short in cases with Asys/PEA, although return of spontaneous circulation (ROSC) before hospital arrival was increasing as TT increased.
[Conclusion] In cases with initial arrest rhythm of VF/VT, EMS could select fully equipped hospital for transportation, even if that hospital is far from the site of OHCA. In cases with Asys/PEA, advanced life support on site might be needed before transportation.
- © 2012 by American Heart Association, Inc.