Impact of cardiopulmonary resuscitation duration on neurologically favourable outcome after out-of-hospital cardiac arrest: A population-based study in Japan

Matsuyama, Tasuku; Kitamura, Tetsuhisa; Kiyohara, Kosuke; Nishiyama, Chika; Nishiuchi, Tatsuya; Hayashi, Yasuyuki; Kawamura, Takashi; Ohta, Bon; Iwami, Taku

doi:10.1016/j.resuscitation.2017.01.005

Cited by 38 publications

(44 citation statements)

References 28 publications

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“…The observation that ROSC, survival and neurological outcomes deteriorate the longer a patient is in cardiac arrest is consistent with previous studies [15][16][17][18]. This underlies the phenomenon known as resuscitation time bias, whereby interventions given early after the onset of cardiac arrest appear to be beneficial relative to late interventions, but the better outcomes are in fact related to earlier treatment [11,19].…”

Section: Discussionsupporting

confidence: 86%

The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial

Perkins

Kenna

et al. 2020

Intensive Care Med

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Purpose: To examine the time to drug administration in patients with a witnessed cardiac arrest enrolled in the Pre-Hospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest (PARAMEDIC2) randomised controlled trial.Methods: The PARAMEDIC2 trial was undertaken across 5 NHS ambulance services in England and Wales with randomisation between December 2014 and October 2017. Patients with an out-of-hospital cardiac arrest who were unresponsive to initial resuscitation attempts were randomly assigned to 1 mg intravenous adrenaline or matching placebo according to treatment packs that were identical apart from treatment number. Participants and study staff were masked to treatment allocation.Results: 8016 patients were enrolled, 4902 sustained a witnessed cardiac arrest of whom 2437 received placebo and 2465 received adrenaline. The odds of return of spontaneous circulation decreased in both groups over time but at a greater rate in the placebo arm odds ratio (OR) 0.93 (95% CI 0.92-0.95) compared with the adrenaline arm OR 0.96 (95% CI 0.95-0.97); interaction OR: 1.03, 95% CI 1.01-1.05, p = 0.005. By contrast, although the rate of survival and favourable neurological outcome decreased as time to treatment increased, the rates did not differ between the adrenaline and placebo groups. Conclusion:The rate of return of spontaneous circulation, survival and favourable neurological outcomes decrease over time. As time to drug treatment increases, adrenaline increases the chances of return of spontaneous circulation. Longer term outcomes were not affected by the time to adrenaline administration. (ISRCTN73485024).

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Section: Discussionsupporting

confidence: 86%

The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial

Perkins

Kenna

et al. 2020

Intensive Care Med

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“…Previous studies have investigated the relationship between duration of cardiopulmonary resuscitation (CPR) until ROSC and outcome. Longer CPR duration was associated with worse (neurologic) outcome after OHCA (4)(5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

“…The resuscitation on scene ends when a patient is either transported to the hospital emergency department (ED) with or without return of spontaneous circulation (ROSC) or when the resuscitation is terminated on scene (1). In general, in only 10% to 50% of patients, ALS results in ROSC on scene (2)(3)(4)(5). Previous studies have investigated the relationship between duration of cardiopulmonary resuscitation (CPR) until ROSC and outcome.…”

Section: Introductionmentioning

confidence: 99%

Time to Return of Spontaneous Circulation and Survival: When to Transport in out-of-Hospital Cardiac Arrest?

Graaf

Donders

Beesems

et al. 2020

Prehospital Emergency Care

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Background: In out-of-hospital cardiac arrest (OHCA), 10-50% of patients have return of spontaneous circulation (ROSC) before hospital arrival. It is important to investigate the relation between time-to-ROSC and survival to determine the optimal timing of transport to the hospital in patients without ROSC. Methods: We analyzed data of OHCA patients with a presumed cardiac cause (excluding traumatic and other obvious non-cardiac causes) and ROSC before hospital arrival from the Amsterdam Resuscitation Study (ARREST) database. ROSC included those patients whose ROSC was persistent or transient before or during transport, lasting !1min. Of these data, we analyzed the association between the time of emergency medical services (EMS) arrival until ROSC (time-to-ROSC) and 30-day survival. Results: Of 3632 OHCA patients with attempted resuscitation, 810 patients with prehospital ROSC were included. Of these, 332 (41%) survived 30 days. Survivors had a significant shorter time-to-ROSC compared to non-survivors of median 5 min (IQR 2,10) vs. median 12 min (IQR 9,17) (p < 0.001). Of the survivors, 90% achieved ROSC within 15 min compared to 22 min of non-survivors. In a multivariable model adjusted for known system determinants time-to-ROSC per minute was significantly associated with 30-day survival (OR 0.89; 95%CI 0.86-0.91). A ROC curve showed 8 min as the time-to-ROSC with the best test performance (sensitivity of 0.72 and specificity of 0.77). Conclusion: In OHCA patients with prehospital ROSC survival significantly decreases with increasing time-to-ROSC. Of all patients, 90% of survivors had achieved ROSC within the first 15 min of EMS resuscitation. The optimal time for the decision to transport is between 8 and 15 min after EMS arrival.

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“…2 Furthermore, patients without a sustained return of spontaneous circulation within the first 30 minutes of their resuscitation, termed refractory arrest, have exceptionally lower rates of good neurological outcome. 3 Fortunately, observational data have shown survival rates with good neurological outcome as high as 30% to 40% for refractory cardiac arrest when using ECPR. [3][4] In their report, Brooks et al identify six high priority questions related to ECPR research and program implementation.…”

mentioning

confidence: 99%

“…3 Fortunately, observational data have shown survival rates with good neurological outcome as high as 30% to 40% for refractory cardiac arrest when using ECPR. [3][4] In their report, Brooks et al identify six high priority questions related to ECPR research and program implementation. Perhaps most importantly, they ask, "What are the best practices in ECPR to optimize neurologically favourable survival?"…”

mentioning

confidence: 99%

Oh, the places we’ll go! Emergency department extracorporeal cardiopulmonary resuscitation (ECPR) in Canada

Gould

Atkinson

Kovács

2018

CJEM

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Impact of cardiopulmonary resuscitation duration on neurologically favourable outcome after out-of-hospital cardiac arrest: A population-based study in Japan

Cited by 38 publications

References 28 publications

The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial

The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial

Time to Return of Spontaneous Circulation and Survival: When to Transport in out-of-Hospital Cardiac Arrest?

Oh, the places we’ll go! Emergency department extracorporeal cardiopulmonary resuscitation (ECPR) in Canada

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