Abstract 361: Time Interval From Collapse to Return of Spontaneous Circulation and Neurologically Intact Survival for Out-of-Hospital Shockable (Ventricular Fibrillation or Pulseless Ventricular Tachycardia) 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 for shockable cardiac arrest (ventricular fibrillation or pulseless ventricular tachycardia).
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 due to shockable arrest, whose ROSC was achieved before hospital arrival and who received post cardiac arrest care after hospital arrival. We 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 cardiac arrest. Of these, 54.5% (6,187/11,621) had a 30-day favorable neurological outcome. The favorable group had a significantly shorter collapse-to-ROSC interval compared to the unfavorable group (13.5±8.2 vs. 19.2±10.7 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, 0.93 to 0.94). Non-linear regression analysis showed that frequency of favorable neurological outcome decreased from 76.4% to 0% for every minute that passed between collapse and ROSC. For favorable neurological outcome, a collapse-to-ROSC interval of 57.5 minute had a sensitivity of 100% with a negative predictive value of 99.8%. Furthermore, a collapse-to-ROSC interval with a sensitivity of 100% for favorable neurological outcome was 55.5 minutes in patients receiving bystander CPR, and 58.5 minutes in patients not receiving bystander CPR.
Conclusion: Resuscitation efforts to achieve ROSC, contributing to neurologically intact survival, are needed for about 60 minutes for patients with witnessed out-of-hospital shockable cardiac arrest irrespective of bystander CPR attempt.
- © 2013 by American Heart Association, Inc.