Association between Cardiac Arrest Time and Favorable Neurological Outcomes in Witnessed Out-of-Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management

Abstract

Background: Patients who achieve a return of spontaneous circulation (ROSC) with prolonged cardiac arrest have been recognized to have a poor prognosis. This might lead to reluctance in the provision of post-resuscitation care. Hence, we evaluated the impact of cardiac arrest time on neurologic outcomes in out-of-hospital cardiac arrest (OHCA) patients. Methods: This cross-sectional study used a hospital-based nationwide registry of OHCAs in Korea between 2012 and 2016. All witnessed OHCA patients aged ≥ 15 years and treated with targeted temperature management were included. We collected the time from collapse to sustained ROSC, which was defined as the downtime. The primary outcome was a favorable neurological outcome at hospital discharge. A multiple logistic regression analysis was conducted to determine independent factors for primary outcome in patients with downtime > 30 minutes. Results: Overall, neurologically favorable outcome rates were 30.5% in 1,963 patients. When the downtime was stratified into categories of 0-10, 11-20, 21-30, 31-40, 41-50, 51-60, and > 60 minutes according to 10-minute intervals, neurologically favorable outcome rates were 58.

The Effects of Extracorporeal Cardiopulmonary Resuscitation According to Covariate Adjustment

“…13 The KCDC reviewed the medical records of all patients with OHCA transported to hospitals by emergency medical service (EMS) personnel, and clinical information was extracted using structured forms based on the Utstein Style and Resuscitation Outcome Consortium Project. 1…”

“…13 The KCDC reviewed the medical records of all patients with OHCA transported to hospitals by emergency medical service (EMS) personnel, and clinical information was extracted using structured forms based on the Utstein Style and Resuscitation Outcome Consortium Project. 1 The Korean EMS system is operated exclusively by the National Fire Agency. All EMS-assessed patients with OHCA are transported to a geographically proximate hospital.…”

“…EMS providers must continue resuscitation efforts until ROSC is achieved at the scene or until arrival at the hospital. 1 All emergency departments (EDs) generally provide advanced cardiac life support, coronary angiography or PCI, and postresuscitation care in accordance with international standard guidelines. Prehospital ECPR is not adopted in Korea; therefore, all ECPR procedures are conducted in a hospital.…”

“…The global survival rate of patients with out-of-hospital cardiac arrest (OHCA) is low. 1 Several studies have focused on the efficacy of extracorporeal cardiopulmonary resuscitation (ECPR) in improving the survival rate of patients with OHCA, and its use has recently increased. 2,3 However, patients who receive ECPR are generally restricted to those who have failed to achieve return of spontaneous circulation (ROSC) despite prolonged conventional cardiopulmonary resuscitation (CCPR).…”

Relationship between cooling time and neurological outcomes in targeted temperature management

“…Out‐of‐hospital cardiac arrest (OHCA) is a global public health problem 1 . In patients who are resuscitated from OHCA, hypoxic brain injury is an important cause of morbidity and mortality 2–4 .…”