Abstract 120: Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest
BACKGROUND: During out-of-hospital cardiac arrest (OHCA), it is unclear how long prehospital cardiopulmonary resuscitation (CPR) efforts should be continued. We investigated whether the duration of prehospital CPR efforts varies according to initial cardiac arrest rhythm and bystander CPR status.
METHODS: From the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of OHCA, 285,192 adult patients who received prehospital CPR efforts after bystander-witnessed OHCA was included. We calculated the time interval from call receipt to return of spontaneous circulation (ROSC) as the length of prehospital CPR efforts. The primary endpoint was favorable 30-day neurological outcome after OHCA.
RESULTS: Of the 285,192 study patients, 32,223 (11.3%) achieved ROSC by hospital arrival. The CPR duration to achieve prehospital ROSC ranged from 1 to 60 min, with a median of 19 min. After adjustment, longer CPR duration resulted in worse neurological outcome (adjusted OR, 0.94; 95% CI, 0.93-0.94). Favorable neurological outcome was: shockable arrest cases receiving bystander CPR, 55.3% (3,931/7,107); shockable arrest cases not receiving bystander CPR, 44.3% (2,129/4,803); non-shockable arrest cases receiving bystander CPR, 8.4% (751/8,946) and non-shockable arrest cases not receiving bystander CPR, 11.1% (1,221/11,016). In non-linear regression analysis for each category, the likelihood of favorable neurological outcome decreased every minute the CPR duration increased (p<0.001, respectively). The CPR duration for favorable neurological outcome associated with 99% or more sensitivity and both 100% sensitivity and negative predictive value ranged from 35 min to 58 min respectively in shockable arrest cases receiving bystander CPR, from 37 min to 57 min respectively in shockable arrest cases not receiving bystander CPR, from 40 min to 55 min respectively in non-shockable arrest cases receiving bystander CPR, and from 39 min to 54 min respectively in non-shockable arrest cases not receiving bystander CPR.
CONCLUSIONS: In adult patients with bystander-witnessed OHCA, prehospital CPR should be continued for at least 35 minutes and up to 58 minutes irrespective of initial cardiac arrest rhythm and bystander CPR status.
Author Disclosures: K. Nagao: None. H. Nonogi: None. N. Yonemoto: None. D.F. Gaieski: None. M. Takayama: None. S. Shirai: None. T. Kimura: None. K. Saku: None.
- © 2014 by American Heart Association, Inc.