Abstract 18304: Are Prolonged Resuscitation Efforts Worthwhile? Patient Outcomes by Time to Restoration of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients
Introduction: How long resuscitation attempts should be continued before termination of efforts is not clear in patients with out-of-hospital cardiac arrest (OHCA). We studied outcomes in patients with return of spontaneous circulation (ROSC) across quartiles of time from 9-1-1 call to ROSC.
Hypothesis: Survival with favorable neurological outcome is seen in all time intervals from 9-1-1 call to ROSC.
Methods: Using data from Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation clinical trials: IMpedance valve and an Early vs. Delayed analysis (PRIMED) available via National Institute of Health, patients with ROSC not witnessed by the emergency medical service (EMS) were identified and grouped by quartiles of time from 9-1-1 call to ROSC. We defined favorable neurological outcome as modified Rankin Scale (mRS) scores of ≤3.
Results: Included were 3,431 OHCA patients with ROSC. Median time from 9-1-1 call to ROSC was 22.8 min (25%-75% 17 min–29.2 min); 953 (27.8%) survived to discharge (20.4% mRS ≤3). Significant survival and favorable neurological outcome were seen in each quartile (Figure). In patients who received bystander cardiopulmonary resuscitation (CPR), survival rates were 60.9%, 33.2%, 18.3% and 11.1% across quartiles of time to ROSC versus (vs.) 51.5%, 25.6%, 13.3% and 8.9% in patients without bystander CPR; corresponding rates of favorable neurological outcome were 50.7%, 23.8%, 12.2% and 9.1% vs. 40.1%, 16.6%, 8% and 4.8%. Correspondingly, survival rates in defibrillated patients were 70.1%, 45.9%, 25.5% and 16.4% vs. 36.3%, 9.5%, 6% and 3.4% in non-defibrillated patients; corresponding rates of favorable neurological outcome were 59.8%, 33.4%, 18.3% and 11.4% vs. 24.4%, 4.1%, 1.9% and 1.8%.
Conclusions: Survival with favorable neurological outcome was seen in all quartiles of time to ROSC, even in cases without bystander CPR or shocks delivered. This suggests that EMS personnel should not terminate resuscitation efforts too early.
Author Disclosures: K. Kragholm: Research Grant; Significant; Laerdal Foundation, The Danish Heart Association. M. Anderson: None. C. Malta Hansen: Research Grant; Significant; Laerdal Foundation, TrygFond Foundation, Helsefonden. P. Schulte: None. M. Kurz: Research Grant; Modest; Zoll Medical Corporation, Rapid Pathogen Screening, Watermark Consulting. E. Fosbol: None. S. Rajan: Research Grant; Significant; TrygFond Foundation, The Danish Heart Foundation, Health Insurance Foundation. M. Wissenberg: Research Grant; Significant; TrygFond Foundation, The Danish Heart Association, Health Insurance Foundation. I. Stiell: None. G. Nichol: None. E. Peterson: Research Grant; Significant; American College of Cardiology, American Heart Association.
- © 2015 by American Heart Association, Inc.