Abstract 319: Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac Arrest: When Should We Change to Novel Therapies?
Objectives: Strategies such as extracorporeal life support yield favorable outcomes in select OHCA patients who fail traditional CPR. However, it is unclear how long to attempt CPR before switching to more intensive strategies. We hypothesized that most patients with good outcome after traditional CPR achieve return of spontaneous circulation (ROSC) quickly, and determined the maximal CPR duration (DUR) required to restore pulses in the majority (75%, 95% or 99%) of patients with good outcome.
Methods: Retrospective cohort study of subjects with atraumatic OHCA and attempted resuscitation from 2005-2011. Good outcome was defined as a modified Rankin scale (mRS) 0-3. We determined DUR until ROSC for subjects with mRS 0-3 (good outcome), mRS 4-5 (poor outcome), or mRS 6 (in-hospital death) with Kaplan-Meier curves, and the association between DUR and good outcome with logistic regression.
Results: Of 1,014 patients, 47% had ROSC, 11% survived, and 6% had mRS 0-3. DUR for each outcome are in Table 1. Cumulative proportions of good outcomes versus DUR are in Figure 1. Adjusting for prehospital and inpatient covariates, DUR (min) is associated with mRS 0-3 (OR 0.84; 95%CI 0.72, 0.98;p=0.02).
Conclusions: Novel strategies should be considered early, because 75% and 90% of patients with good outcome have ROSC within 10 and 16 minutes of traditional resuscitation, respectively.
- © 2013 by American Heart Association, Inc.