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 resuscitation efforts should be continued to maximize lives saved.
Methods and Results—Between 2005 and 2012, we enrolled 282,183 adult patients with bystander-witnessed OHCA from the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation (ROSC) in cases achieving prehospital ROSC or from call receipt to hospital arrival in cases not achieving prehospital ROSC. In each of four groups stratified by initial cardiac arrest rhythm (shockable versus non-shockable) and bystander resuscitation (presence versus absence), we calculated minimum prehospital resuscitation duration, defined as the length of resuscitation efforts in minutes required to achieve ≥99% sensitivity for the primary endpoint, favorable 30-day neurological outcome after OHCA. Prehospital resuscitation duration to achieve prehospital ROSC ranged from 1 to 60 minutes. Longer prehospital resuscitation duration reduced the likelihood of favorable neurological outcome (adjusted odds ratio, 0.84; 95% confidence interval, 0.838-0.844). Although the frequency of favorable neurological outcome was significantly different between the four groups, ranging from 20.0% (shockable/bystander resuscitation group) to 0.9% (non-shockable/bystander resuscitation group) [P<0.001], minimum prehospital resuscitation duration did not differ widely between the four groups (40 minutes in the shockable/bystander resuscitation group and the shockable/no bystander resuscitation group, 44 minutes in the non-shockable/bystander resuscitation group and 45 minutes in the non-shockable/no bystander resuscitation group).
Conclusions—Based on time intervals from the shockable arrest groups, prehospital resuscitation efforts should be continued for at least 40 minutes in all adults with bystander-witnessed OHCA.
Clinical Trial Registration Information—www.umin.ac.jp/ctr/. Identifier: 000009918.
- Received August 4, 2015.
- Revision received January 26, 2016.
- Accepted January 29, 2016.