Association between duration of return of spontaneous circulation and outcomes after out-of-hospital cardiac arrest

Abstract

BackgroundReturn of spontaneous circulation (ROSC) is a core outcome element of cardiopulmonary resuscitation (CPR); however, the definition or criterion of ROSC is disputed and varies in resuscitation for out-of-hospital cardiac arrest (OHCA).MethodsThis was a retrospective study of 126 patients with OHCA who achieved ROSC between January and December 2020. The probability of survival after OHCA related to CPR and ROSC duration was analyzed using the probability density function and empirical cumulative density functions.ResultsThere were no significant differences between ROSC sustained until emergency department arrival and that sustained for at least 20 minutes in terms of the 24-hour survival rate (31.3% [31/99] vs. 35.7% [10/30]; P = 0.84), 30-day survival rate (23.2% [23/99] vs. 25.0% [7/30]; P = 0.99), or survival at 30 days with cerebral performance category (CPC) 1 and 2 (18.2% [18/99] vs. 10.7% [3/30]; P = 0.44). The Kolmogorov-Smirnov test values from the empirical cumulative density functions with ROSC sustained until hospital arrival and that sustained for at least 20 minutes were 0.44, 0.20, and 0.24 for CPC 1 or 2, CPC 3 or 4, and CPC 5, respectively.ConclusionReturn of spontaneous circulation is a core outcome element of CPR. It should be defined as sustained for at least 20 minutes or until arrival at the emergency department and as a basic standard for evaluating resuscitation success after OHCA.

Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients

“…When DABI was measured quantitatively using GWR BG , it is important to note that adjusting for initial cardiac rhythm and time to ROSC nullifies the significance of this association. This is not an unexpected finding, as these factors are known predictors of outcome in post-cardiac arrest patients ( 16 , 17 ). Additionally, previous studies have suggested that GWR is misleadingly higher when CTH is performed within 6 hours of arrest and will be more accurate beyond this timeframe ( 18 ).…”

“…Furthermore, the body temperatures recorded in this study included axillary and ear temperatures, which are not true core body temperature measurements, and may have overestimated the number of patients in the lower body temperature group who were truly normothermic (15). Finally, some of these studies did not control for time to ROSC and other features of the cardiac arrest event that are known to contribute to mortality (11, 15–17).…”

Treatment of Comatose Survivors of in-Hospital Cardiac Arrest With Extended Endovascular Cooling Method for 72 H: A Propensity Score-Matched Analysis

“…The ROSC was defined as the return of blood circulation without continuous chest compressions. Sustained ROSC was defined as ROSC lasting at least 20 min (33). Cardiopulmonary resuscitation duration was recorded as the time interval from the beginning of the application of chest pressure to the termination of cardiopulmonary resuscitation (34,35).…”