Abstract 15159: Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest: Implications for Prolonging Resuscitation
Introduction: Little evidence guides the duration of resuscitation (CPR-DUR) in OHCA. We estimated the impact of CPR-DUR on the probability of favorable neurologic outcome at hospital discharge (mRS 0-3) in OHCA using a large, multi-center cohort.
Hypothesis: CPR-DUR is associated with mRS 0-3, and this association is modified by case features.
Methods: Secondary analysis of multi-center clinical trial (ROC-PRIMED) of adult, atraumatic, EMS-treated, OHCA. Primary exposure was CPR-DUR (professional CPR to ROSC or termination). Primary outcome was mRS 0-3. Subjects were also classified as survival with poor outcome (mRS 4-5), ROSC without survival (mRS 6), or no ROSC. We plotted subject accrual as a function of CPR-DUR, and estimated dynamic probabilities of mRS 0-3 for the whole cohort and subject phenotypes (shockable rhythm [VF/VT], witnessed [WIT], bystander CPR [bCPR]). Adjusted logistic regression models tested associations between CPR-DUR and mRS 0-3 with interaction terms for VF/VT, WIT, and bCPR.
Results: Primary cohort was 11,368 subjects (69 [IQR: 56-81] years; 63% male; 47% WIT; 38% bCPR; 22% VF/VT; 85% advanced airway; 14% induced hypothermia; 31% cardiac catheterization). Of these, 4,023 (35.4%) had ROSC, 1,232 (10.8%) survived to discharge, and 905 (8.0%) had mRS 0-3. Distribution of CPR-DUR differed by outcome (p<0.001). After 37.0 min (95%CI 34.9-40.9 min), 99% with eventual mRS 0-3 achieved ROSC. Dynamic probability of mRS 0-3 declined over CPR-DUR, but subjects with VF/VT, WIT, and bCPR had resilience to prolonged efforts with significant interaction terms (Figure). Adjusting for prehospital (OR 0.93; 95%CI 0.92-0.95) and inpatient (OR 0.97; 95%CI 0.95-0.99) covariates, CPR-DUR was associated with mRS 0-3.
Conclusions: CPR-DUR was associated with mRS 0-3 at hospital discharge. Subjects with favorable phenotypes had resilience to prolonged resuscitation, warranting either continued efforts or early consideration of novel therapies.
Author Disclosures: J.C. Reynolds: None. B.E. Grunau: None. J.C. Rittenberger: Research Grant; Significant; AHA grant. K.N. Sawyer: None. M.C. Kurz: None. C.W. Callaway: None.
- © 2016 by American Heart Association, Inc.