Cardiopulmonary resuscitation duration and favorable neurological outcome after out-of-hospital cardiac arrest: a nationwide multicenter observational study in Japan (the JAAM-OHCA registry)

Abstract

Objective We aimed to assess the association between cardiopulmonary resuscitation (CPR duration) and outcomes after OHCA. Methods This secondary analysis of a prospective, multicenter, observational study included adult non-traumatic OHCA patients aged ≥ 18 years between June 2014 and December 2017. CPR duration was defined as the time from professional CPR initiation to the time of return of spontaneous circulation or termination of resuscitation. The primary outcome was 1-month survival, with favorable neurological outcomes defined by cerebral performance category 1 or 2. We performed multivariable logistic regression analysis to investigate the association between CPR duration and favorable neurological outcomes. We also investigated the association between CPR duration and favorable neurological outcomes stratified by case features, including the first documented cardiac rhythm, witnessed status, and presence of bystander CPR. Results A total of 23,803 patients were included in this analysis. Multivariable logistic regression analysis demonstrated that the probability of favorable neurological outcomes decreased with CPR duration (i.e., 20.8% [226/1084] in the ≤ 20 min group versus 0.0% [0/708] in the 91–120 min group, P for trend < 0.001). Furthermore, the impact of CPR duration differed depending on the presence of case features; those with shockable, witnessed arrest, and bystander CPR were more likely to achieve favorable neurological outcomes after prolonged CPR duration > 30 min. Conclusion The probability of favorable neurological outcome rapidly decreased within a few minutes of CPR duration. But, the impact of CPR duration may be influenced by each patient’s clinical feature.

Perinatal Azithromycin Provides Limited Neuroprotection in an Ovine Model of Neonatal Hypoxic-Ischemic Encephalopathy

“…42 Earlier ROSC has important clinical significance, as it typically is associated with better outcomes. 43 Finally, we observed slight improvements in neurodevelopmental outcomes only at early time points. Azithromycin-treated animals were less encephalopathic and more vigorous compared with placebo-treated animals at early time points.…”

A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study

“…Multiple studies have shown a strong relation between low-flow time and survival [ 3 , 23 , 24 ]. ECPR is proposed as a way to further improve survival rates by means of shortening the low-flow time in patients with refractory cardiac arrest.…”

“…Of the patients who survive an Out-of-Hospital-Cardiac-Arrest (OHCA), approximately 90% achieves return of spontaneous circulation (ROSC) within 15 min [ 1 ]. In case of refractory arrest, often defined as ROSC not obtained within 20 min, favourable neurological outcome is uncommon (OR 0.03) [ 1 – 3 ]. Currently, patients failing to reach ROSC are either declared deceased on-site or transported to the hospital for further treatment, including potential Extracorporeal Cardiopulmonary Resuscitation (ECPR) eligibility.…”

Extracorporeal cardiopulmonary resuscitation in 2023

“…The first published randomized trial on ECPR was the ARREST trial published 2020 demonstrating a striking 43% good neurological survival (CPC 1–2 after 6 months) in the ECPR group opposed to 0% in the no-ECPR group [ 30 ]; see Table 2 . At first glance, this seems plausible, since survival strongly declines with longer low-flow durations after OHCA [ 53 , 98 , 99 ], and IHCA [ 100 ]. Importantly, however, mortality without ECPR in selected patients (with witnessed arrest, immediate CCPR, younger age, shockable rhythm, treatable cause of arrest, etc.)…”

“…Importantly, however, mortality without ECPR in selected patients (with witnessed arrest, immediate CCPR, younger age, shockable rhythm, treatable cause of arrest, etc.) even with longer low-flow durations is not 100% [ 53 , 98 , 99 ]. It is no coincidence that predictors of better outcome in CCPR (see above) are considered go-criteria for ECPR [ 11 , 37 ].…”