Abstract 11542: Relationship between Neurologically Intact Survival after Return of Spontaneous Circulation (ROSC) from Out-of-Hospital Cardiac Arrest and Time Interval from Collapse to ROSC
BACKGROUND Although early achievement of ROSC is critical to neurologically intact survival from cardiac arrest, few data are available in any cardiac arrest rhythm. METHODS From the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest, 12,216 adult patients who achieved ROSC after bystander-witnessed out-of-hospital cardiac arrest due to cardiac etiology were included; 7,129 achieved ROSC after shockable arrest (shockable group) and 5,087 achieved ROSC after non-shockable arrest (non-shockable group). The primary end point was 30-day favorable neurological outcome after cardiac arrest. RESULTS Frequency of favorable neurological outcome was seen 4,556 (37.3%) of all 12,216 patients. The shockable group was a significantly higher frequency of favorable neurological outcome than the non-shockable group (52.9% vs. 15.5%, p<0.0001). The shockable group was a significantly shorter collapse-to-ROSC interval than the non-shockable group (mean±SD; 18.1±8.8 min vs. 23.3±11.4 min, p<0.0001). When ROSC was achieved within the first minute of collapse, frequency of favorable neurological outcome was approximately 90% in the shockable group and approximately 50% in the non-shockable group, and then the frequency decreased in both groups for every 1 min increment in the increasing collapse-to-ROSC interval. Finally, the frequency resulted in approximately 0% when ROSC was delayed beyond 60 min in the shockable group, and beyond 50 min in the non-shockable group (non-liner regression model, p<0.0001, respectively). Adjusted odds ratio for favorable neurological outcome after collapse-to-ROSC interval was 0.93 (95% CI; 0.92 to 0.93) in the shockable group, and 0.92 (95% CI; 0.91 to 0.93) in the non-shockable group. In each group, the other independent predictors were age, dispatcher-instruction of CPR, bystander CPR, EMS-responder CPR using a 30:2 compression-ventilation ratio, a 1-shock protocol when indicated. CONCLUSION For every minute that passes between collapse and ROSC, neurologically intact survival rates decreased from 90% to 0% for 60 minutes in the shockable arrest, and from 50% to 0% for 50 minutes in the non-shockable arrest.
- Cardiopulmonary resuscitation
- Cardiac arrest
- Ventricular fibrillation
- Emergency care
- Post cardiac arrest care
- © 2012 by American Heart Association, Inc.