Abstract 195: Survival in Out-of-Hospital Cardiac Arrest Patients Without a Prehospital Return of Spontaneous Circulation
Background: Survival rates are low in out-of-hospital cardiac arrest (OHCA) patients transported without a prehospital return of spontaneous circulation (ROSC). Few studies have examined the patient characteristics and prehospital factors associated with improved survival in this unique cohort.
Objective: This study aims to describe patient and prehospital factors associated with survival to hospital discharge when patients fail to achieve ROSC in the field.
Methods: This was a retrospective observational study of consecutive adult (≥18 years) OHCA patients without a prehospital ROSC from December 1, 2005 to March 30, 2012 who were attended to and transported by emergency medical services (EMS) from urban and rural regions employing the current termination of resuscitation (TOR) guidelines. EMS witnessed cardiac arrests, and cardiac arrests of non-cardiac etiology were excluded. Bivariate analyses were used to determine associations of patient characteristics and prehospital variables with survival to hospital discharge.
Results: There were 17,488 OHCA treated by EMS, with 4,892 (28.0%) transported to hospital without a prehospital ROSC. Of these patients, only 42 (0.86%) survived to hospital discharge. Survivors were often younger with initial shockable rhythms, had OHCA that were more often witnessed by bystanders and occurred in public locations, compared to non-survivors (table). No differences were noted in the proportion of male gender, bystander CPR rates, EMS response time, advanced airway, or ALS provider level. Three patients (0.06%) did not meet the criteria for transport in accordance with current TOR guidelines however were transported at the discretion of EMS and survived.
Conclusion: Less than 1% (the threshold for futility) of OHCA patients without a prehospital ROSC survived to hospital discharge. Survival in this cohort was associated with younger age, shockable initial rhythms, bystander-witnessed arrests, and public location.
- © 2012 by American Heart Association, Inc.