Abstract 154: Relation Between Time Interval From Collapse to Return of Spontaneous Circulation and Neurologically Intact Survival for Out-of-Hospital Cardiac Arrest
Background: Although early achievement of return of spontaneous circulation (ROSC) after cardiac arrest is critical to neurologically intact survival, few data are available concerning this interval.
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 and who received post cardiac arrest care by physicians after hospital arrival. We evaluated the relationship between favorable neurological outcome 30 days after cardiac arrest and the time interval from collapse to ROSC.
Results: Of the 284,814 patients with witnessed OHCA, 31,845 (11.2%) achieved ROSC. Of those achieving ROSC, 8,714 (27.4%) had 30-day favorable neurological outcome. The favorable group had a significantly shorter collapse-to-ROSC interval than the unfavorable group (13.2±8.4 vs. 21.7±12.0 minutes, 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 (adjusted OR; 0.94, 95% CI, 0.94 to 0.94). Non-linear regression analysis showed that the frequency of favorable neurological outcome decreased from 56.8% to 0% for every minute that passed in the collapse-to-ROSC interval. For favorable neurological outcome, a collapse-to-ROSC interval of 57.5 minutes had a sensitivity of 100% with a negative predictive value of 99.6%, and that of 38.5 minutes had a sensitivity of 99.0% with a negative predictive value of 90.7%.
Conclusion: Resuscitation efforts to achieve ROSC, contributing to neurologically intact survival, are needed for at least 38.5 minutes in patients with witnessed OHCA.
- © 2013 by American Heart Association, Inc.