Abstract 13569: Neurologically Intact Survival and Time Interval From Collapse to Return of Spontaneous Circulation for Patients With Out-of-Hospital Cardiac Arrest; A Comparison of Shockable Cardiac Arrest and Non-Shockable Cardiac Arrest
Background: Early achievement of return of spontaneous circulation (ROSC) after cardiac arrest is critical to neurologically intact survival, but few data are available concerning this interval comparing shockable arrest and non-shockable arrest.
Methods: From the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest (OHCA) between 2005 and 2011, we included adult patients who received resuscitation care after witnessed OHCA, whose ROSC was achieved before hospital arrival. We divided study patients into two groups according to the initial cardiac rhythm and evaluated the relationship between the collapse-to-ROSC interval and favorable neurological outcome 30 days after cardiac arrest.
Results: Of the 31,845 patients who achieved ROSC after witnessed OHCA, 11,621 (36.5%) achieved ROSC after shockable arrest and 20,224 (63.5%) after non-shockable arrest. The shockable group had a significantly shorter collapse-to-ROSC interval compared with the non-shockable group (16.2±9.9 vs. 21.2±12.4 minutes, p<0.0001) and a significantly higher frequency of 30-day favorable neurological outcome (53.2% vs. 12.5%, p<0.0001). After adjustment for resuscitation, the likelihood of favorable neurological outcome decreased for every 1 minute increment in the collapse-to-ROSC interval in the shockable group (adjusted OR; 0.94, 95% CI, 0.93 to 0.94) and in the non-shockable group (adjusted OR; 0.93, 95% CI, 0.93 to 0.94). Non-linear regression analysis showed that the frequency of favorable neurological outcome decreased from 76.4% to 0% in the shockable group and from 35.4% to 0% in the non-shockable group. For favorable neurological outcome, a collapse-to-ROSC interval of 57.5 minutes had a sensitivity of 100% with a negative predictive value of 99.8% in the shockable group, and that of 56.5 minutes had a sensitivity of 100% with a negative predictive value of 99.4% in the non-shockable group.
CONCLUSION: In patients achieving ROSC after witnessed OHCA, shockable arrest patients had a significantly higher favorable neurological outcome than non-shockable patients. However, the interval in which resuscitation efforts must be sustained is similar for both arrest rhythms.
- © 2013 by American Heart Association, Inc.