Comparing the prognosis of those with initial shockable and non-shockable rhythms with increasing durations of CPR: Informing minimum durations of resuscitation

Grunau, Brian; Reynolds, Joshua C.; Scheuermeyer, Frank; Stenstrom, Robert; Pennington, Sarah; Cheung, Christopher C.; Li, Jennifer; Habibi, Mehdi; Ramanathan, Krishnan; Barbic, David; Christenson, Jim

doi:10.1016/j.resuscitation.2016.01.021

Cited by 100 publications

(50 citation statements)

References 20 publications

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“…These findings are consistent with Grunau, et al and Nehme, et al who studied the impact of shockable initial cardiac rhythm and EMS-witnessed cardiac arrest on resuscitation duration and survival in a single EMS system. [23,24] They found higher ‘resilience’ to resuscitation lasting 30-40 minutes in subjects with shockable initial cardiac rhythms and EMS-witnessed cardiac arrest. Nonetheless, we expect that beyond some ultimate duration of resuscitation, incremental survival becomes asymptotic.…”

Section: Discussionmentioning

confidence: 99%

Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest

et al. 2016

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Background Little evidence guides the appropriate duration of resuscitation in out-of-hospital cardiac arrest (OHCA), and case features justifying longer or shorter durations are ill-defined. We estimated the impact of resuscitation duration on the probability of favorable functional outcome in OHCA using a large, multi-center cohort. Methods Secondary analysis of a North American, single blind, multi-center, cluster-randomized clinical trial (ROC-PRIMED) of consecutive adults with non-traumatic, EMS-treated, OHCA. Primary exposure was duration of resuscitation in minutes (onset of professional resuscitation to return of spontaneous circulation [ROSC] or termination of resuscitation). Primary outcome was survival to hospital discharge with favorable outcome (modified Rankin scale [mRS] 0-3). Subjects were additionally classified as survival with unfavorable outcome (mRS 4-5), ROSC without survival (mRS 6), or without ROSC. Subject accrual was plotted as a function of resuscitation duration, and the dynamic probability of favorable outcome at discharge was estimated for the whole cohort and subgroups. Adjusted logistic regression models tested the association between resuscitation duration and survival with favorable outcome. Results The primary cohort included 11,368 subjects (median age 69 years [IQR: 56-81 years]; 7,121 men [62.6%]). Of these, 4,023 (35.4%) achieved ROSC, 1,232 (10.8%) survived to hospital discharge, and 905 (8.0%) had mRS 0-3 at discharge. Distribution of CPR duration differed by outcome (p<0.00001). For CPR duration up to 37.0 minutes (95%CI 34.9-40.9 minutes), 99% with eventual mRS 0-3 at discharge achieved ROSC. Dynamic probability of mRS 0-3 at discharge declined over elapsed resuscitation duration, but subjects with initial shockable cardiac rhythm, witnessed cardiac arrest, and bystander CPR were more likely to survive with favorable outcome after prolonged efforts (30-40 minutes). Adjusting for prehospital (OR 0.93; 95%CI 0.92-0.95) and inpatient (OR 0.97; 95%CI 0.95-0.99) covariates, resuscitation duration was associated with survival to discharge with mRS 0-3. Conclusions Shorter resuscitation duration was associated with likelihood of favorable outcome at hospital discharge. Subjects with favorable case features were more likely to survive prolonged resuscitation up to 47 minutes.

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Section: Discussionmentioning

confidence: 99%

Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest

et al. 2016

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“…In addition, a large-scale multicenter study has evaluated these issues and patients with initial shockable rhythms or age <65 years were found to have a reasonable chance of neurologically intact survival, even with extraordinarily long downtimes (22). Another study assessed the relationship between resuscitation time and outcomes and suggested 48 minutes of shockable rhythms and 15 min of non-shockable rhythms as the optimal resuscitation duration, at which time the probability of survival fell to <1% (which can be defined as futile resuscitation) (23). However, the 2011 NAEMSP position statement on TOR states that no significant numerical value can be confidently recommended due to the lack of evidence (24).…”

Section: Editorialmentioning

confidence: 99%

What should we consider when applying termination of resuscitation rules?

Yoon

Kim

2016

J. Thorac. Dis.

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“…witnessed arrest, initial shockable rhythm, bystander CPR), presence of potentially reversible causes may guide clinicians to continue with resuscitation efforts for longer. In a recent analysis, the elapsed duration at which the probability of survival fell below 1% was 48 and 15 min in the shockable and non-shockable groups, respectively (52). A secondary analysis of 11,368 cases of OHCA from the US ROC-PRIMED (Resuscitation Outcomes Consortium Prehospital Resuscitation Using an Impedance Valve and Early Versus Delayed) identified that that with conventional resuscitation, 90% of patients with good outcome achieved initial ROSC within 20 minutes and 99% within 37 minutes (53).…”

Section: Refractory Arrest: Transport or Termination Of Resuscitation?mentioning

confidence: 98%

Out-of-hospital cardiac arrest: prehospital management

2018

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(no more than 150 words)Sudden out of hospital cardiac arrest is the most time critical medical emergency. In this expert opinion and literature review, we consider important issues in the pre-hospital management of cardiac arrest. Successful resuscitation is reliant on a strong chain of survival drawn from the community, dispatch center, ambulance and hospital working together. Early cardiopulmonary resuscitation and defibrillation has the greatest impact on survival. If the community response does not restart the heart, resuscitation is continued by emergency medical services staff. There is uncertainty about the best approaches for airway management and the effectiveness of current drug treatments. Prognostic factors and termination of resuscitation rules may guide the duration of a resuscitation attempt and decision to transport to hospital. If return of spontaneous circulation is achieved, the focus of treatment shifts to stabilization, restoring normal physiological parameters and transporting to hospital for on-going care.2

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Comparing the prognosis of those with initial shockable and non-shockable rhythms with increasing durations of CPR: Informing minimum durations of resuscitation

Cited by 100 publications

References 20 publications

Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest

Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest

What should we consider when applying termination of resuscitation rules?

Out-of-hospital cardiac arrest: prehospital management

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