Abstract 325: Differences in the Implications of the Time Interval from Collapse to Initiation of Cardiopulmonary Resuscitation and to Return of Spontaneous Circulation for the Prognosis of Out-of-Hospital Cardiac Arrest Patients
Introduction: Out-of-hospital cardiac arrest patients have a poor prognosis even if cardiopulmonary resuscitation (CPR) is administered. The time interval from collapse to initiation of CPR (CA-CPR) and the time interval from collapse to return of spontaneous circulation (CA-ROSC) are reported to be predictors of survival in cardiac arrest patients. However, the clinical implications of both durations remain unclear.
Hypothesis: We assessed the hypothesis that CA-CPR and CA-ROSC have different impacts on the prognosis of out-of-hospital cardiac arrest patients.
Methods: We enrolled adult out-of-hospital cardiac arrest patients between 2006 and 2010 in this study. Receiver-operating characteristic curves of CA-CPR and CA-ROSC were generated to analyse favourable neurological outcomes. We assessed the independent predictors of return of spontaneous circulation (ROSC) and favourable neurological outcomes by using the logistic regression model. A P value of < 0.05 was considered statistically significant.
Results: We enrolled 1194 patients. The median age was 74 y (interquartile range 61-83 y); 61% were males. Fifty-two percent of the patients involved witnessed cardiac arrest; 76% of the patients were received by-stander CPR, 11% of the patients whose initial recorded rhythm was shockable rhythm. The CA-CPR for patients who achieved ROSC (n = 422) was shorter than that for patients who did not achieved ROSC (7 min (1-14 min) vs. 19 min (8-51 min), P < 0.001). From the patients who achieved ROSC, the patients who had favourable neurological outcomes had shorter CA-CPR (2 min (1-7 min) vs. 8 min (2-15 min), P < 0.001) and CA-ROSC (13 min (9-22 min) vs. 46 min (34-58 min), P < 0.001). The area under the curve for the CA-CPR predicting ROSC was 0.74. The area under the curve for the CA-CPR and the CA-ROSC predicting favourable neurological outcomes in patients who achieved ROSC was 0.69 and 0.89, respectively. Multivariable analysis showed that the CA-CPR was associated with ROSC and CA-ROSC but not A-CPR was associated with favourable neurological outcomes.
Conclusions: Early initiation of CPR is associated with ROSC, and early ROSC in turn is associated with favourable neurological outcomes in out-of-hospital cardiac arrest patients.
- Acute coronary syndromes
- Extracorporeal circulation
- Percutaneous coronary intervention
- Cardiac arrest
- © 2012 by American Heart Association, Inc.