Abstract 61: Neurological Outcomes Associated with Duration of Prehospital Resuscitation: Implications for Transport to Invasive Resuscitation
Objective: The likelihood of survival to hospital discharge after out-of-hospital cardiac arrest (OHCA) varies between 5% and 17% in North America. Historically, EMS has provided most treatments available in hospital, thus transport of intra-arrest patients has been discouraged. Invasive therapies such as extracorporeal-CPR however, require re-evaluation of this practice. We explored the probability of favourable neurological outcomes in relation to the time of first ROSC, potentially highlighting the appropriate time to consider transport.
Methods: Prospectively identified consecutive non-traumatic OHCA’s in a British Columbia region between September 2007 and December 2011 underwent a detailed chart review. We analyzed the association of time to first ROSC with cerebral performance category (CPC) at hospital discharge, dichotomized as favourable (1-2) or unfavorable (3-5).
Results: Of 2505 regional OHCA’s, 1730 were treated by EMS; 1720 subjects with outcome data available were analyzed (median age 68 (IQR 55 - 81), 66% male, 46% witnessed OHCA, 50% bystander or immediate EMS CPR, 25% initial shockable rhythms). There were 223 (13%) survivors at discharge, with 171 (10%) CPC 1-2. Of those with CPC 1-2, the median time to ROSC was 7.5 minutes (IQR 3.9 - 13.8), and ROSC occurred at ≤ 15 and ≤ 20 minutes in 81% (95% CI 74-86) and 88% (95% CI 82-92) respectively. The probability of favourable neurological outcome at hospital discharge after 15 and 20 minutes without ROSC was 2.5% (95% CI 1.8 - 3.5) and 1.8% (95% CI 1.2 - 2.7) respectively. Time to ROSC was independently associated with the probability of an unfavourable neurologic outcome (OR 1.11 per minute; 95% CI 1.1 - 1.2).
Conclusion: The likelihood of an unfavourable neurological outcome increased with pre-hospital resuscitation time to ROSC. OHCA patients without ROSC after 20 minutes have a low chance of good neurological outcome. The benefit of transport to in-hospital invasive resuscitation should be explored.
Author Disclosures: B.E. Grunau: None. D. Stub: None. R. Stenstrom: None. J.C. Reynolds: None. J. Li: None. C. Cheung: None. K. Ramanathan: None. S. Carriere: None. M. Habibi: None. F.X. Scheuermeyer: None. S. Pennington: None. R. Boone: None. A. Cheung: None. J. Christenson: None.
- © 2014 by American Heart Association, Inc.