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Is initial rhythm in OHCA a predictor of preceding no flow time? Implications for bystander response and ECPR candidacy evaluation.

Abstract：

OBJECTIVE:Shockable cardiac rhythms are associated with improved outcomes among out-of-hospital cardiac arrests (OHCA). Initial cardiac rhythm may also be predictive of a short preceding no-flow duration. We examined the relationship between no-flow duration and initial cardiac rhythm, which may demonstrate the urgency in rescuer response and assist with candidacy evaluation for extracorporeal-cardiopulmonary resuscitation (ECPR). METHODS:We examined consecutive adult OHCA's identified by a prospective registry in British Columbia (2005-2016). We included those with witnessed OHCA but no bystander CPR. The variable of interest was no-flow duration, defined as time from 9-1-1 call to EMS arrival. We fit an adjusted logistic regression model to estimate the association of no-flow duration and initial cardiac rhythm. Among those with shockable initial rhythms, we calculated the cumulative proportion with no-flow durations under incremental time cut-offs. RESULTS:Of 26 621 EMS-treated OHCA's, 2532 were included. Overall survival was 13.8%, and 34% had initial shockable rhythms. The probability of having an initial shockable rhythm decreased with increasing no-flow durations (adjusted OR 0.88 per minute, 95% CI 0.85-0.91). Among those found with initial shockable rhythms, 94% (95% CI 92-96%) had a no-flow time under 10 min. CONCLUSION:The odds of a shockable initial rhythm declined with each additional minute of no-flow time, highlighting the importance of early access to defibrillation. Among those with initial shockable rhythms, the preceding no-flow duration was highly likely to be under 10 min, which may inform decisions about ECPR candidacy among select patients with unwitnessed arrests.

journal_name

Resuscitation

journal_title

Resuscitation

authors

Tanguay-Rioux X,Grunau B,Neumar R,Tallon J,Boone R,Christenson J

doi

10.1016/j.resuscitation.2018.05.002

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

88-92

eissn

0300-9572

issn

1873-1570

pii

S0300-9572(18)30213-2

journal_volume

128

pub_type

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