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Duration of cardiopulmonary resuscitation in patients without prehospital return of spontaneous circulation after out-of-hospital cardiac arrest: Results from a severity stratification analysis.

Abstract：

BACKGROUND:The relationship between duration of cardiopulmonary resuscitation (CPR) and post-arrest outcomes based on severity stratification in out-of-hospital cardiac arrest (OHCA) patients without prehospital return of spontaneous circulation (ROSC) remains unclear. METHODS:We analysed 420,959 adult patients without prehospital ROSC in the All-Japan OHCA registry for 4 years. Prehospital CPR duration was defined as the time from CPR initiation by emergency medical service (EMS) providers to hospital arrival. The primary outcome was 1-month neurologically intact survival (cerebral performance category 1 or 2, CPC 1-2). RESULTS:The rate of overall 1-month CPC 1-2 was 0.45% (1899/420,959). Using recursive partitioning analysis to predict 1-month CPC 1-2, we stratified patients into 4 groups with 3 predictors: patients aged <75 years with initial shockable rhythm (1-month CPC 1-2 rate, 6.15%), those aged ≥75 years with initial shockable rhythm (1.32%), those with EMS-witnessed arrest and initial non-shockable rhythm (1.62%), and those with EMS-unwitnessed arrest and initial non-shockable rhythm (0.15%). Prehospital CPR duration was negatively associated with 1-month CPC 1-2 (adjusted odds ratio 0.94 per 1-min increment; 95% confidence interval 0.94-0.95). Prehospital CPR durations beyond which the dynamic probability of 1-month CPC 1-2 decreased to <1% were 26 min, 10 min, 7 min, and at all times in above-mentioned stratification, respectively. CONCLUSIONS:In OHCA patients without prehospital ROSC, those aged <75 years with initial shockable rhythm had acceptable 1-month CPC 1-2 rate. However, CPR efforts lasting 26 min or over before hospital arrival could be futile.

journal_name

Resuscitation

journal_title

Resuscitation

authors

Funada A,Goto Y,Tada H,Teramoto R,Shimojima M,Hayashi K,Kawashiri MA,Yamagishi M

doi

10.1016/j.resuscitation.2018.01.008

subject

Has Abstract

pub_date

2018-03-01 00:00:00

pages

69-75

eissn

0300-9572

issn

1873-1570

pii

S0300-9572(18)30008-X

journal_volume

124

pub_type

杂志文章

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Duration of cardiopulmonary resuscitation in patients without prehospital return of spontaneous circulation after out-of-hospital cardiac arrest: Results from a severity stratification analysis.