Abstract 2012: Relationship Between Adrenaline Concentration and Postresuscitation Syndrome in Patients with Return of Spontaneous Circulation (ROSC) After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kei Nishikawa ◽  
Ken Nagao ◽  
Kimio Kikushima ◽  
Kazuhiro Watanabe ◽  
Eizo Tachibana ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Epinephrine Administration ◽  
Cutoff Value ◽  
Neurological Outcomes ◽  
A Prospective Study ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background Although there is evidence that epinephrine hydrochloride favors initial ROSC, there is a paucity of evidence that it improves survival in humans. The value and safety of the Î 2 -adrenergic effects of epinephrine is controversial because they may lead to increase postresuscitation syndrome after ROSC. Few studies have investigated whether adrenaline concentration before epinephrine administration was related to incidence of postresuscitation syndrome. METHODS We did a prospective study of adult patients who achieved ROSC with standard cardiopulmonary resuscitation after out-of-hospital cardiac arrest. Blood samples to measure the adrenaline concentration were taken from a vein. The primary endpoint was neurological outcomes at hospital discharge. RESULTS Of the 274 adult patients with out-of-hospital cardiac arrest, 108(39%) achieved ROSC. The adrenaline levels ranged from 53 to 15,329pg/ml, with a median of 1,545pg/ml, and 25th and 75th percentile values of 707 and 4,486pg/ml, respectively. Of those, 71% (77/108) had an unfavorable neurological outcome and the adrenaline level was higher among such patients than among those with a favorable neurological outcome (a median, 2,016pg/ml vs. 938pg/ml, p=0.048). Moreover, the adrenaline level was higher among patients who died of postresuscitation syndrome within 24 hours of ROSC than among those with survival at 24 hours (a median, 3,290pg/ml vs. 1,343pg/ml, p=0.038). The adrenaline cutoff value of 944pg/ml for unfavorable neurological outcome had an accuracy of 70%. The adjusted odds ratio for the unfavorable neurological outcome after adrenaline cutoff value of 944pg/ml was 8.9 (95% CI, 2.2–35.9; p=0.002). On the other hand, the adrenaline level after epinephrine administration was 28 times as high as that before epinephrine administration (a median, 42,868pg/ml vs. 1,545pg/ml, p<0.0001). CONCLUSIONS In adult patients with ROSC after out-of-hospital cardiac arrest, adrenaline level before epinephrine administration was associated with incidence of postresuscitation syndrome, and the level was extremely increased after epinephrine administration. Epinephrine administration may lead to a severe toxic hyperadrenergic state in postresuscitation period.

Abstract 152: Effect of the 2010 CPR Guidelines for Patients With Out-of-Hospital Cardiac Arrest Due to Non-Shockable Rhythm

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Tadashi Ashida ◽  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Shigemasa Tani ◽  
Eizo Tachibana ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Multivariable Analysis ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Shockable Rhythm ◽  
Class Iib ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: The 2010 guidelines have stressed that systematic post-cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good neurological outcome. However, the 2010 guidelines showed that induced therapeutic hypothermia may be considered for comatose adult patients with ROSC after out-of-hospital cardiac arrest (OHCA) with an initial rhythm of non-shockable (Class IIb). It is unknown whether the post-cardiac arrest care for patients with non-shockable cardiac arrest contributed to favorable neurological outcome. The aim of the present study was to clarify the effects of the 2010 guidelines in patients with ROSC after cardiac arrest due to non-shockable rhythm, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of OHCA. Methods: From the data of this registry between 2005 and 2015, we included adult patients with ROSC after out-of-hospital non-shockable cardiac arrest due to cardiac etiology. Study patients were divided into three groups based on the different CPR guidelines; the era of the 2000 guidelines (2000G), the era of the 2005 guidelines (2005G), and the era of the 2010 guidelines (2010G). The endpoint was favorable neurological outcome at 30 days after OHCA. Results: The 31,204 patients who met the inclusion criteria comprised 25,045 with ROSC before arrival at the hospital and 6,259 with ROSC after hospital arrival without prehospital ROSC. Figure showed favorable neurological outcome at 30 days in the three groups. Moreover, multivariable analysis showed that the 2010 guidelines were an independent predictor of favorable neurological outcome at 30 days after OHCA, respectively (Figure). Conclusion: In the patients with ROSC after out-of-hospital non-shockable cardiac arrest, the 2010 guidelines were superior to the 2005 guidelines and the 2000 guidelines, in terms of neurological benefits.

Abstract 342: The Relationship Between Time Interval From Collapse to Return of Spontaneous Circulation After Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ken Nagao ◽  
Yoshio Tahara ◽  
Hiroshi Nonogi ◽  
Naohiro Yonemoto ◽  
David F Gaieski ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Time Interval ◽  
Return Of Spontaneous Circulation ◽  
Favorable Neurological Outcome ◽  
The Relationship ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Background: Early cardiopulmonary resuscitation (CPR) and early defibrillation are critical to survival from out-of-hospital cardiac arrest (OHCA). However, few studies have investigated the relationship between time interval from collapse to return of spontaneous circulation (ROSC) and neurologically intact survival. Methods: From the All-Japan OHCA Utstein Registry between 2005 and 2015, we enrolled adult patients achieving prehospital ROSC after witnessed OHCA, inclusive of arrest after emergency medical service responder arrival. The study patients were divided into two groups according to initial cardiac arrest rhythm (shockable versus non-shockable). The collapse-to-ROSC interval was calculated as the time interval from collapse to first achievement of prehospital ROSC. The primary endpoint was 30-day favorable neurological outcome after OHCA. Results: A total of 69,208 adult patients achieving prehospital ROSC after witnessed OHCA were enrolled; 23,017(33.3%) the shockable arrest group and 46,191 (66.7%) the non-shockable arrest group. The shockable arrest group compared with the non-shockable arrest group had significantly shorter collapse-to-ROSC interval (16±10 min vs. 20±13 min, P<0.001) and significantly higher frequency of the favorable neurological outcome (54.9% vs. 15.3%, P<0.001). Frequencies of the favorable neurological outcome after shockable OHCA decreased to 1.2% to 1.5% with every minute that the collapse-to-ROSC interval was delayed (78% at 1 minute of collapse, 68% at 10 minutes, 44% at 20 minutes, 34% at 30 minutes, 16% at 40 minutes, 4% at 50 minutes and 0% at 60 minutes, respectively, P<0.001), and those after non-shockable OHCA decreased to 0.8% to 1.8% with every minute that the collapse-to-ROSC interval was delayed (40% at 1 minute of collapse, 26% at 10 minutes, 11% at 20 minutes, 5% at 30 minutes, 2% at 40 minutes, 0% at 50 minutes and 0% at 60 minutes, respectively, P<0.001). Conclusions: Termination of the collapse-to-ROSC interval to achieve neurologically intact survival after witnessed OHCA was 50 minutes or longer irrespective of initial cardiac arrest rhythm (shockable versus non-shockable), although the neurologically intact survival rate was difference between the two groups.

Abstract 155: Effect of the 2010 CPR Guidelines for Patients With Out-of-Hospital Cardiac Arrest Due to Shockable Rhythm

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Yoji Watanabe ◽  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Shigemasa Tani ◽  
Eizo Tachibana ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Multivariable Analysis ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Adult Patients ◽  
Shockable Rhythm ◽  
Favorable Neurological Outcome ◽  
Population Based Registry ◽  
Hospital Cardiac Arrest

Background: The 2010 guidelines have stressed that systematic post-cardiac arrest care after return of spontaneous circulation (ROSC) can improve the likelihood of patient survival with good neurological outcome. Especially, the 2010 guidelines recommended that comatose adult patients with ROSC after out-of-hospital ventricular fibrillation (VF) cardiac arrest should be induced therapeutic hypothermia (Class I). However, it is unknown whether the post-cardiac arrest care which was recommended by the 2010 guidelines contributed to favorable neurological outcome. The aim of the present study was to clarify the effects of the 2010 guidelines in patients with ROSC after cardiac arrest due to shockable rhythm, using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital cardiac arrest (OHCA). Methods: From the data of this registry between 2005 and 2015, we included adult patients with ROSC after out-of-hospital shockable cardiac arrest due to cardiac etiology. Study patients were divided into three groups based on the different CPR guidelines; the era of the 2000 guidelines (2000G), the era of the 2005 guidelines (2005G), and the era of the 2010 guidelines (2010G). The primary endpoint was favorable neurological outcome at 30 days after OHCA. Results: The 30,518 patients who met the inclusion criteria comprised 24,729 with ROSC before arrival at the hospital and 5,789 with ROSC after hospital arrival without prehospital ROSC. Figure showed favorable neurological outcome at 30 days in the three groups. Moreover, multivariable analysis showed that the 2010 guidelines were an independent predictor of favorable neurological outcome at 30 days after OHCA, respectively (Figure). Conclusion: In the patients with ROSC after out-of-hospital shockable cardiac arrest, the 2010 guidelines were superior to the 2005 guidelines and the 2000 guidelines, in terms of neurological benefits.

Abstract 199: Pulmonary Embolism and Accidental Hypothermia Have a Favorable Outcome in Cardiac Arrest With PEA Treated by ECPR

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Shinichi Ijuin ◽  
Akihiko Inoue ◽  
Nobuaki Igarashi ◽  
Shigenari Matsuyama ◽  
Tetsunori Kawase ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Cerebral Performance Category ◽  
Accidental Hypothermia ◽  
Neurological Outcomes ◽  
Good Outcome ◽  
Group B ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: We have reported previously a favorable neurological outcome by extracorporeal cardiopulmonary resuscitation (ECPR) for out of hospital cardiac arrest. However, effects of ECPR on patients with prolonged pulseless electrical activity (PEA) are unclear. We analyzed etiology of patients with favorable neurological outcomes after ECPR for PEA with witness. Methods: In this single center retrospective study, from January 2007 to May 2018, we identified 68 patients who underwent ECPR for PEA with witness. Of these, 13 patients (19%) had good neurological outcome at 1 month (Glasgow-Pittsburgh Cerebral Performance Category (CPC):1-2, Group G), and 55 patients (81%) had unfavorable neurological outcome (CPC:3-5, Group B). We compared courses of treatment and causes/places of arrests between two groups. Results are expressed as mean ± SD. Results: Patient characteristics were not different between the two groups. Time intervals from collapse to induction of V-A ECMO were also not significantly different (Group G; 46.1 ± 20.2 min vs Group B; 46.8 ± 21.7 min, p=0.92). Ten patients achieved favorable neurological outcome among 39 (26%) with non-cardiac etiology. In cardiac etiology, only 3 of 29 patients (9%) had a good outcome at 1 month (p=0.08). In particular, 5 patients of 10 pulmonary embolism, and 4 of 4 accidental hypothermia responded well to ECPR with a favorable neurological outcome. Additionally, 6 of 13 (46%), who had in hospital cardiac arrest, had good outcome, whereas 7 of 55 (15%) who had out of hospital cardiac arrest, had good outcome (p=0.02). Conclusions: In our small cohort of cardiac arrest patients with pulmonary embolism or accidental hypothermia and PEA with witness, EPCR contributed to favorable neurological outcomes at 1 month.

Abstract 44: Time to Epinephrine Impacts Mortality Following Pediatric In-Hospital Nonshockable Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Lars W Andersen ◽  
Katherine Berg ◽  
Brian Z Saindon ◽  
Joseph M Massaro ◽  
Tia T Raymond ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
National Registry ◽  
Epinephrine Administration ◽  
Negatively Associated ◽  
Logistic Regression Models ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Background: Delay in administration of the first epinephrine dose has been shown to be associated with a lower chance of good outcome in adult, in-hospital, non-shockable cardiac arrest. Whether this association is true in pediatric in-hospital non-shockable cardiac arrest remains unknown. Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify pediatric patients (age < 18 years) with an in-hospital cardiac arrest between 2000 and 2010. We included patients with an initial non-shockable rhythm who received at least one dose of epinephrine. To assess the association between time to epinephrine administration and survival to discharge we used multivariate logistic regression models with adjustment for multiple predetermined variables including age, gender, illness category, pre-existing mechanical ventilation, monitored, witnessed, location, time of the day/week, year of arrest, insertion of an airway, initial rhythm, time to initiation of cardiopulmonary resuscitation, hospital type and hospital teaching status. Secondary outcomes included return of spontaneous circulation (ROSC) and neurological outcome. Results: 1,131 patients were included. Median age was 9 months (quartiles: 21 days - 6 years) and 46% were female. Overall survival to hospital discharge was 29%. Longer time to epinephrine was negatively associated with survival to discharge in multivariate analysis (OR: 0.94 [95%CI: 0.90 - 0.98], per minute delay). Longer time to epinephrine was negatively associated with ROSC (OR: 0.93 [95%CI: 0.90 - 0.97], per minute delay) but was not statistically significantly associated with survival with good neurological outcome (OR: 0.95 [95%CI: 0.89 - 1.03], per minute delay). Conclusions: Delay in administration of epinephrine during pediatric in-hospital cardiac arrest with a non-shockable rhythm is associated with a lower chance of ROSC and lower survival to hospital discharge.

scholarly journals Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest

2022 ◽  
Vol 30 (1) ◽  
Author(s):  
SungJoon Park ◽  
Sung Woo Lee ◽  
Kap Su Han ◽  
Eui Jung Lee ◽  
Dong-Hyun Jang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Neurological Outcome ◽  
Patient Characteristics ◽  
Related Factors ◽  
Neurological Outcomes ◽  
Upper Limit ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest ◽  
Off Time

Abstract Background A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR. Methods We conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service–assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge. Results Among 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55–62 and 24–34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43–53 and 45–71 min, respectively. Conclusions Herein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient’s resuscitation-related factors, despite prolonged CPR duration.

Abstract 186: Sex Differences in Outcomes for Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Pavitra Kotini-Shah ◽  
Oksana Pugach ◽  
Ruizhe Chen ◽  
Marina Del Rios ◽  
Kimberly Vellano ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
Sex Differences ◽  
Coronary Angiography ◽  
Neurological Outcome ◽  
The United States ◽  
Neurological Outcomes ◽  
Bystander Cpr ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: Approximately 1,000 out-of-hospital cardiac arrest (OHCA) occur per day in the United States. Although survival rates remains low, the extent to which OHCA neurological outcomes differ between men and women remains poorly characterized. Methods: Within the national Cardiac Arrest Registry to Enhance Survival (CARES) registry, we identified 195,722 adult individuals with an OHCA between 2013-2017. Using multi-variable logistic regression models, we evaluated for sex differences in rates of survival to hospital discharge and favorable neurological outcome (survival with discharge CPC score of 1 or 2), adjusted for cardiac arrest characteristics, race, location, year of arrest, age, and use of targeted temperature management (TTM) and coronary angiography. Results: Overall, 70,767 (31%) patients were women. Median age was 64 and 62 years for women and men, respectively. An initial shockable rhythm (14.9% vs. 25.7%) and a witnessed arrest (40.9% vs. 45.6%) was more common in men. Bystander CPR was provided to 37% of women and 39% of men. Men were less likely to survive to hospital discharge than women (8.7% vs. 10.9%; adjusted OR 0.75, 95% CI 0.73, 0.78). Similarly, men were less likely to have favorable neurological outcome (6.6% vs. 9.2% for women; adjusted OR 0.78, 95% CI 0.74, 0.82). Further interaction analysis for the pre-hospital elements found small, but statistically significant sex differences in favorable neurological survival for witnessed status (among female OR 2.29, 95% CI 2.10, 2.49; among males OR 2.07, 95% CI 1.92, 2.23, p= 0.04) and for bystander CPR (among females OR 1.20, 95% CI 1.11, 1.29; among males OR 1.34, 95% CI 1.27, 1.42, p= 0.01). Interaction of sex with the hospital level variables of TTM and coronary angiography, for the subset of patients that survived to hospital admission, had no sex differences in favorable neurological outcome. Conclusion: Our analysis shows that for OHCA in the United States, women have better survival outcomes than men. There was a sex differences in the pre-hospital variable of BCPR, but not in the other modifiable variables of TTM and coronary angiography. Further study is needed to better understand sex differences in overall survival and neurological outcomes.

Abstract 132: Neurological Favorable Outcome Associated With Number of Prehospital Defibrillation Attempts in Out-of-Hospital Cardiac Arrest Without Return of Spontaneous Circulation on Scene

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Seulki Choi ◽  
Tae Han Kim ◽  
Ki Jeong Hong ◽  
Sung Wook Song ◽  
Joo Jeong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Life Support ◽  
Discharge Rate ◽  
Spontaneous Circulation ◽  
Successful Resuscitation ◽  
Return Of Spontaneous Circulation ◽  
Hospital Transport ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: The early and timely defibrillation in shockable rhythm of out-of-hospital cardiac arrest (OHCA) by prehospital EMS providers is crucial for successful resuscitation. In emergency medical service (EMS) system, where advanced cardiac life support could not be fully provided before hospital transport, optimal range of prehospital defibrillation attempts is debatable. We evaluated association between number of prehospital defibrillation attempts and survival outcomes in OHCA patients who were unresponsive to field resuscitation and defibrillations. Methods: This is a retrospective observational study using nationwide OHCA registry of Korea from 2013 to 2016. Adult EMS treated OHCA with presumed cardiac origin with shockable initial ECG rhythm were enrolled. Final analysis was performed in patients who did not achieve return of spontaneous circulation (ROSC) on scene before hospital transport. We categorized number of prehospital defibrillation attempt into 3 groups: ≤3 attempts, 4-5 attempts and ≥6 attempts. Primary outcome was favorable neurological outcome at hospital discharge. Multivariable logistic regression modeling was used to evaluate association between neurological outcome and defibrillation attempts. Result: Total 6,679 patients were enrolled for final analyzed. Among total ≤3 defibrillations were attempted in 5015 patients (75.1%), 1050 patients (15.7%) for 4-5 attempts, 614 patient. (9.2%) for ≥6 attempts. Although survival to discharge rate was highest in group with ≤3 defibrillation attempts (8.1% vs. 7.0% vs. 2.9%, p<0.01), survival rate with favorable neurological outcome was highest in group with 4-5 defibrillation attempts (3.0% vs. 4.5% vs. 2.1%, p=0.02). As 4-5 attempts group reference, adjusted odds ratio for favorable neurological outcome of ≤3 attempts was 0.66 (95% CI 0.46 - 0.94) and of ≥6 attempts was 0.47 (95% CI 0.25 - 0.89). Conclusion: For patients with shockable initial cardiac rhythm who were unresponsive to filed defibrillation and resuscitation, moderate amount of defibrillation attempt was associated with favorable neurological outcome compared to fewer defibrillation attempts and prolonged number of defibrillation attempts on scene.

Abstract 18304: Are Prolonged Resuscitation Efforts Worthwhile? Patient Outcomes by Time to Restoration of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kristian Kragholm ◽  
Monique Anderson ◽  
Carolina Malta Hansen ◽  
Phillip J. Schulte ◽  
Michael C. Kurz ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Significant Survival ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Using Data ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: How long resuscitation attempts should be continued before termination of efforts is not clear in patients with out-of-hospital cardiac arrest (OHCA). We studied outcomes in patients with return of spontaneous circulation (ROSC) across quartiles of time from 9-1-1 call to ROSC. Hypothesis: Survival with favorable neurological outcome is seen in all time intervals from 9-1-1 call to ROSC. Methods: Using data from Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation clinical trials: IMpedance valve and an Early vs. Delayed analysis (PRIMED) available via National Institute of Health, patients with ROSC not witnessed by the emergency medical service (EMS) were identified and grouped by quartiles of time from 9-1-1 call to ROSC. We defined favorable neurological outcome as modified Rankin Scale (mRS) scores of ≤3. Results: Included were 3,431 OHCA patients with ROSC. Median time from 9-1-1 call to ROSC was 22.8 min (25%-75% 17 min–29.2 min); 953 (27.8%) survived to discharge (20.4% mRS ≤3). Significant survival and favorable neurological outcome were seen in each quartile (Figure). In patients who received bystander cardiopulmonary resuscitation (CPR), survival rates were 60.9%, 33.2%, 18.3% and 11.1% across quartiles of time to ROSC versus (vs.) 51.5%, 25.6%, 13.3% and 8.9% in patients without bystander CPR; corresponding rates of favorable neurological outcome were 50.7%, 23.8%, 12.2% and 9.1% vs. 40.1%, 16.6%, 8% and 4.8%. Correspondingly, survival rates in defibrillated patients were 70.1%, 45.9%, 25.5% and 16.4% vs. 36.3%, 9.5%, 6% and 3.4% in non-defibrillated patients; corresponding rates of favorable neurological outcome were 59.8%, 33.4%, 18.3% and 11.4% vs. 24.4%, 4.1%, 1.9% and 1.8%. Conclusions: Survival with favorable neurological outcome was seen in all quartiles of time to ROSC, even in cases without bystander CPR or shocks delivered. This suggests that EMS personnel should not terminate resuscitation efforts too early.

Abstract 265: Impact of Changes in the Telephone Cardiopulmonary Resuscitation Instruction After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ken Nagao ◽  
Hiroyuki Hanada ◽  
Yoshio Tahara ◽  
Hiroshi Nonogi ◽  
Naohiro Yonemoto ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Neurological Outcome ◽  
Group Versus ◽  
Adult Patients ◽  
Similar Proportion ◽  
International Consensus ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: The international consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science with treatment recommendations (CoSTR) 2010 changed the dispatcher-initiated telephone CPR instruction. Major changes of the telephone CPR instruction were simplified algorithm, elimination of “Look, listen, and feel for breathing” chest compressions first (C-A-B), chest compression only CPR if bystander was not trained in CPR, et al. However, few studies have investigated the efficacy of telephone CPR instruction based on the CoSTR 2010. Methods: From the All-Japan Utstein Registry for out-of-hospital cardiac arrest (OHCA) between 2006 and 2015, we enrolled adult (18 years or older) patients with bystander-witnessed OHCA and stratified by the two CoSTR eras (the CoSTR 2010 group from 2011 through 2015 versus the CoSTR 2005 group from 2006 through 2010). The primary endpoint was 30-day favorable neurological outcome after OHCA. Results: Of the 378,757 adult patients with bystander-witnessed OHCA, 199,117 (52.5%) received CPR based on the CoSTR 2010 and 179,640 (47.4%) received CPR based on the CoSTR 2005. In the whole cohort, the CoSTR 2010 group had higher proportion of cases receiving telephone CPR instruction than the CoSTR 2005 group (48.8% versus 40.9%, P<0.001). In the subgroups of patients receiving telephone CPR instruction, the CoSTR 2010 group had higher proportion of bystander chest compression-only CPR (60.5% versus 47.3%, p<0.001) and public access defibrillation (1.9% versus 0.9%, P<0.001) than the CoSTR 2005 group. Although those subgroups had similar proportion of initial shockable cardiac arrest rhythm (15.2 % in the CoSTR 2010 group versus 15.3 % in the CoSTR 2005 group, P=0.63), the CoSTR 2010 group had higher frequency of the favorable neurological outcome than the CoSTR 2005 group (4.5 % versus 3.7%%, P<0.001). In the subgroup of patients receiving telephone CPR instruction, an adjusted odds ratio for the favorable neurological outcome in the CoSTR 2010 group (reference, the CoSTR 2005 group) was 1.47 (95 % CI, 1.43-1.51, p<0.001). Conclusions: Telephone CPR instruction based on the CoSTR 2010 was the preferable approach to resuscitation for adult patients with bystander-witnessed OHCA.

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