Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest

Nagao, Ken; Nonogi, Hiroshi; Yonemoto, Naohiro; Gaieski, David F.; Ito, Noritoshi; Takayama, Morimasa; Shirai, Shinichi; Furuya, Singo; Tani, Sigemasa; Kimura, Takeshi; Saku, Keijiro

doi:10.1161/circulationaha.115.018788

Cited by 139 publications

(112 citation statements)

References 29 publications

(59 reference statements)

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“…The longest duration of CPR with a patient that survived with a good neurological outcome was 47 minutes (Reynolds et al, 2016). Similar results were also found in large observational studies performed in Japan (Goto, Funada, & Goto, 2016;Nagao et al, 2016).…”

Section: When Should a First-aid Provider Stop Cprsupporting

confidence: 90%

When Should a First-Aid Provider Stop CPR: Answer from the American Red Cross Scientific Advisory Council

Jones¹,

Bradley²

2017

IJFAE

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Section: When Should a First-aid Provider Stop Cprsupporting

confidence: 90%

When Should a First-Aid Provider Stop CPR: Answer from the American Red Cross Scientific Advisory Council

Jones¹,

Bradley²

2017

IJFAE

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“…CA is a time‐dependent pathology,1 and the majority of patients with CA are found more than 10 minutes after their arrest occurred 2, 3. Patients with long untreated arrest times have the worst outcomes,2, 3, 4 in part because there is much to learn about the injury sustained by patients resuscitated from prolonged CA.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with long untreated arrest times have the worst outcomes,2, 3, 4 in part because there is much to learn about the injury sustained by patients resuscitated from prolonged CA. The loss of blood flow caused by CA is widely acknowledged to cause a metabolic pathology, but we struggle to measure the effect of this pathology at the bedside.…”

Section: Introductionmentioning

confidence: 99%

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Shinozaki

Becker

Saeki³

et al. 2018

JAHA

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BackgroundThe concept that resuscitation from cardiac arrest (CA) results in a metabolic injury is broadly accepted, yet patients never receive this diagnosis. We sought to find evidence of metabolic injuries after CA by measuring O2 consumption and CO2 production (VCO 2) in a rodent model. In addition, we tested the effect of inspired 100% O2 on the metabolism.Methods and ResultsRats were anesthetized and randomized into 3 groups: resuscitation from 10‐minute asphyxia with inhaled 100% O2 (CA–fraction of inspired O2 [FIO2] 1.0), with 30% O2 (CA‐FIO 2 0.3), and sham with 30% O2 (sham‐FIO 2 0.3). Animals were resuscitated with manual cardiopulmonary resuscitation. The volume of extracted O2 (VO 2) and VCO 2 were measured for a 2‐hour period after resuscitation. The respiratory quotient (RQ) was RQ=VCO 2/VO 2. VCO 2 was elevated in CA‐FIO 2 1.0 and CA‐FIO 2 0.3 when compared with sham‐FIO 2 0.3 in minutes 5 to 40 after resuscitation (CA‐FIO 2 1.0: 16.7±2.2, P<0.01; CA‐FIO 2 0.3: 17.4±1.4, P<0.01; versus sham‐FIO 2 0.3: 13.6±1.1 mL/kg per minute), and then returned to normal. VO 2 in CA‐FIO 2 1.0 and CA‐FIO 2 0.3 increased gradually and was significantly higher than sham‐FIO 2 0.3 2 hours after resuscitation (CA‐FIO 2 1.0: 28.7±6.7, P<0.01; CA‐FIO 2 0.3: 24.4±2.3, P<0.01; versus sham‐FIO 2 0.3: 15.8±2.4 mL/kg per minute). The RQ of CA animals persistently decreased (CA‐FIO 2 1.0: 0.54±0.12 versus CA‐FIO 2 0.3: 0.68±0.05 versus sham‐FIO 2 0.3: 0.93±0.11, P<0.01 overall).Conclusions CA altered cellular metabolism resulting in increased VO 2 with normal VCO 2. Normal VCO 2 suggests that the postresuscitation Krebs cycle is operating at a presumably healthy rate. Increased VO 2 in the face of normal VCO 2 suggests a significant alteration in O2 utilization in postresuscitation. Several RQ values fell well outside the normally cited range of 0.7 to 1.0. Higher FIO 2 may increase VO 2, leading to even lower RQ values.

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“…1- 4 Recently, several studies have investigated the relationship between CPR duration and outcome, and in particular according to initial documented rhythm. [5][6][7][8][9][10][11] crew consists of 3 EMS staff members, including at least 1 emergency lifesaving technician (ELST). ELSTs are allowed to use various resuscitation methods, including for whom resuscitation was attempted after OHCA in Japan between January 2011 and December 2014.…”

Section: Study Design and Data Sourcementioning

confidence: 99%

Age-Specific Differences in the Duration of Prehospital Cardiopulmonary Resuscitation Administered by Emergency Medical Service Providers Necessary to Achieve Favorable Neurological Outcome After Out-of-Hospital Cardiac Arrest

Funada

Goto

Tada

et al. 2017

Circ J

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Background:The appropriate duration of prehospital cardiopulmonary resuscitation (CPR) administered by emergency medical service (EMS) providers for patients with out-of-hospital cardiac arrest (OHCA) necessary to achieve 1-month survival with favorable neurological outcome (Cerebral Performance Category 1 or 2, CPC 1-2) is unclear and could differ by age. Methods and Results:We analyzed the records of 35,709 adult OHCA patients with return of spontaneous circulation (ROSC) before hospital arrival in a prospectively recorded Japanese registry between 2011 and 2014. The CPR duration was defined as the time from CPR initiation by EMS providers to prehospital ROSC. The rate of 1-month CPC 1-2 was 21.4% (7,650/35,709). The CPR duration was independently and inversely associated with 1-month CPC 1-2 (adjusted odds ratio, 0.93 per 1-min increment; 95% confidence interval, 0.93-0.94). The CPR duration increased with age (P<0.001). However, the CPR duration beyond which the proportion of OHCA patients with 1-month CPC 1-2 decreased to <1% declined with age: 28 min for patients aged 18-64 years, 25 min for 65-74 years, 23 min for 75-84 years, 20 min for 85-94 years, and 18 min for ≥95 years. Conclusions:In patients who achieved prehospital ROSC after OHCA, the duration of CPR administered by EMS providers necessary to achieve 1-month CPC 1-2 varied by age.Key Words: Aging; Cardiopulmonary resuscitation; Epidemiology; Out-of-hospital cardiac arrest ORIGINAL ARTICLE Arrhythmia/ElectrophysiologyCirculation Journal Vol.81, May 2017 653 CPR Duration and Outcomes After OHCA by Age crew consists of 3 EMS staff members, including at least 1 emergency lifesaving technician (ELST). ELSTs are allowed to use various resuscitation methods, including for whom resuscitation was attempted after OHCA in Japan between January 2011 and December 2014. Some data from this patient cohort from January 2011 to December 2012 have been reported as part of other analyses investigating the relationship between CPR duration and initial documented rhythm. 6 Cardiac arrest was defined as the cessation of cardiac mechanical activity as confirmed by the absence of signs of circulation. The cause of arrest was presumed to be cardiac unless evidence suggested an external cause, respiratory disease, cerebrovascular disease, malignant tumor, or any other noncardiac cause. Physicians in charge made the determination of the cause of arrest in collaboration with EMS providers.This study was approved by the Ethics Committee of Kanazawa University with a waiver of informed consent because of the anonymous nature of the data. The Japanese EMS SystemJapan has approximately 127 million residents in an area of 378,000 km 2 . Details of the Japanese EMS system have been described previously. 13 The FDMA of Japan supervises the national EMS system. Each local EMS system is operated by the local fire station. In general, an ambulance whether ROSC was achieved before arrival at the hospital, time of the emergency call, time of vehicle arrival at the scene, time of CPR ...

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Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest

Cited by 139 publications

References 29 publications

When Should a First-Aid Provider Stop CPR: Answer from the American Red Cross Scientific Advisory Council

When Should a First-Aid Provider Stop CPR: Answer from the American Red Cross Scientific Advisory Council

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Age-Specific Differences in the Duration of Prehospital Cardiopulmonary Resuscitation Administered by Emergency Medical Service Providers Necessary to Achieve Favorable Neurological Outcome After Out-of-Hospital Cardiac Arrest

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