Abstract 309: Prediction Chart for Neurological Outcomes of Elderly Patients with Out-of-hospital Cardiac Arrest and the Corresponding Time to Termination of Resuscitation: Evidence from a Japanese Nationwide Population-based Cohort Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Akira Funada ◽  
Yoshikazu Goto ◽  
Masayuki Takamura
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Elderly Patients ◽  
Service Providers ◽  
Patient Characteristics ◽  
Case Scenario ◽  
Worst Case ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Neurological outcomes and the appropriate duration from call receipt to termination of resuscitation (TOR) in patients with out-of-hospital cardiac arrest (OHCA) could differ according to patient characteristics. Hypothesis: We hypothesized that a prediction chart comprising prehospital variables, including age, could be useful for predicting neurological outcomes and determining the time to TOR in the field or at the emergency department. Methods: We evaluated 19,829 elderly patients with OHCA (age ≥65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC). Data were obtained from the prospectively recorded All-Japan Utstein Registry between 2011 and 2016. Patients with OHCA witnessed by emergency medical service providers were excluded. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1-2. Patients with OHCA were divided into 12 groups according to shockable rhythm (YES/NO), witness status (YES/NO), and age (65-74, 75-89, or ≥90 years). The time from call receipt to ROSC was calculated and categorized by 5-min intervals. The time from call receipt to ROSC at which the probability of 1-month CPC 1-2 decreased to <1% was defined as the call to TOR duration. Results: The overall 1-month CPC 1-2 rate was 18.9% (n = 3,756). When stratified by patient characteristics, the 1-month CPC 1-2 rates ranged from 52.3% in patients aged 65-74 years with shockable rhythm and witnessed OHCA (best-case scenario) to 1.6% in patients aged ≥90 years with non-shockable rhythm and un-witnessed OHCA (worst-case scenario). The corresponding call to TOR duration ranged from 35 to 10 min (Table). Conclusions: Neurological outcomes and the appropriate call to TOR duration differed according to patient characteristics, including age. Our prediction chart for elderly patients with OHCA could be useful for determining TOR in the field or at the emergency department.

scholarly journals Outcomes of out-of-hospital cardiac arrest in Beijing: a 5-year cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e041917
Author(s):  
Fei Shao ◽  
Haibin Li ◽  
Shengkui Ma ◽  
Dou Li ◽  
Chunsheng Li
Keyword(s):  
Cardiac Arrest ◽  
Urban Areas ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Term Survival ◽  
Shockable Rhythm ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

ObjectiveThe purpose of this study was to assess the trends in outcomes of out-of-hospital cardiac arrest (OHCA) in Beijing over 5 years.DesignCross-sectional study.MethodsAdult patients with OHCA of all aetiologies who were treated by the Beijing emergency medical service (EMS) between January 2013 and December 2017 were analysed. Data were collected using the Utstein Style. Cases were followed up for 1 year. Descriptive statistics were used to characterise the sample and logistic regression was performed.ResultsOverall, 5016 patients with OHCA underwent attempted resuscitation by the EMS in urban areas of Beijing during the study period. Survival to hospital discharge was 1.2% in 2013 and 1.6% in 2017 (adjusted rate ratio=1.0, p for trend=0.60). Survival to admission and neurological outcome at discharge did not significantly improve from 2013 to 2017. Patient characteristics and the aetiology and location of cardiac arrest were consistent, but there was a decrease in the initial shockable rhythm (from 6.5% to 5.6%) over the 5 years. The rate of bystander cardiopulmonary resuscitation (CPR) increased steadily over the years (from 10.4% to 19.4%).ConclusionSurvival after OHCA in urban areas of Beijing did not improve significantly over 5 years, with long-term survival being unchanged, although the rate of bystander CPR increased steadily, which enhanced the outcomes of patients who underwent bystander CPR.

scholarly journals Impact of cooling method on the outcome of initial shockable or non-shockable out of hospital cardiac arrest patients receiving target temperature management: a nationwide multicentre cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Makoto Watanabe ◽  
Tasuku Matsuyama ◽  
Hikaru Oe ◽  
Makoto Sasaki ◽  
Yuki Nakamura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score Analysis ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Multivariable Logistic Regression Analysis ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Score Analysis ◽  
Hospital Cardiac Arrest ◽  
Cooling Methods

Abstract Background Little is known about the effectiveness of surface cooling (SC) and endovascular cooling (EC) on the outcome of out-of-hospital cardiac arrest (OHCA) patients receiving target temperature management (TTM) according to their initial rhythm. Methods We retrospectively analysed data from the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest registry, a multicentre, prospective nationwide database in Japan. For our analysis, OHCA patients aged ≥ 18 years who were treated with TTM between June 2014 and December 2017 were included. The primary outcome was 30-day survival with favourable neurological outcome defined as a Glasgow–Pittsburgh cerebral performance category score of 1 or 2. Cooling methods were divided into the following groups: SC (ice packs, fans, air blankets, and surface gel pads) and EC (endovascular catheters and any dialysis technique). We investigated the efficacy of the two categories of cooling methods in two different patient groups divided according to their initially documented rhythm at the scene (shockable or non-shockable) using multivariable logistic regression analysis and propensity score analysis with inverse probability weighting (IPW). Results In the final analysis, 1082 patients were included. Of these, 513 (47.4%) had an initial shockable rhythm and 569 (52.6%) had an initial non-shockable rhythm. The proportion of patients with favourable neurological outcomes in SC and EC was 59.9% vs. 58.3% (264/441 vs. 42/72), and 11.8% (58/490) vs. 21.5% (17/79) in the initial shockable patients and the initial non-shockable patients, respectively. In the multivariable logistic regression analysis, differences between the two cooling methods were not observed among the initial shockable patients (adjusted odd ratio [AOR] 1.51, 95% CI 0.76–3.03), while EC was associated with better neurological outcome among the initial non-shockable patients (AOR 2.21, 95% CI 1.19–4.11). This association was constant in propensity score analysis with IPW (OR 1.40, 95% CI 0.83–2.36; OR 1.87, 95% CI 1.01–3.47 among the initial shockable and non-shockable patients, respectively). Conclusion We suggested that the use of EC was associated with better neurological outcomes in OHCA patients with initial non-shockable rhythm, but not in those with initial shockable rhythm. A TTM implementation strategy based on initial rhythm may be important.

Qualitative and quantitative analysis of emergency department cardiac arrest publications

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Prediction Models ◽  
Patient Characteristics ◽  
Research Direction ◽  
Medical Emergency ◽  
Aggregated Data ◽  
Academic Publications ◽  
Relationship Of ◽  
Hospital Cardiac Arrest

Cardiac arrest is a medical emergency with a poor prognosis. Patient characteristics and outcomes are associated with location and are traditionally categorized into out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Increasing evidence has revealed that cardiac arrest occurring in the emergency department is distinct from OHCA or IHCA in other locations in hospitals, but most academic publications combine these populations and apply the knowledge arising from OHCA or IHCA to patients with emergency department cardiac arrest (EDCA). The aim of this study was to identify the research direction of EDCA in the past 20 years and to analyze the characteristics and content of academic publications. We searched the MEDLINE and EMBASE databases for eligible articles until May 30, 2021. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data underwent a scoping review and analyzed qualitatively and quantitatively. In total, 52 original articles investigating EDCA were included; only 15 articles simply focused on EDCA, while other articles involved OHCA or IHCA simultaneously. There were 3 articles discussing the relationship of overcrowdedness and EDCA, 12 articles for prediction and risk factors associated with EDCA, 15 articles for epidemiology and prognosis, and 22 articles for specific diagnostic or resuscitation skills with regard to EDCA. Studies focusing on EDCA are increasing but still scarce. Applying the knowledge arising from OHCA or IHCA to EDCA is questionable, and research focused on EDCA is necessary. ED overcrowdedness-associated EDCA and prediction models for EDCA are essential topics that need further investigation.

Abstract 165: Hospital Variation in Time to Administration of Epinephrine After Cardiac Arrest With Initial Non-shockable Rhythm

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Rohan Khera ◽  
Paul S Chan ◽  
Michael W Donnino ◽  
Saket Girotra ◽  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Inverse Correlation ◽  
Poor Performance ◽  
Patient Characteristics ◽  
Hospital Performance ◽  
Epinephrine Administration ◽  
Shockable Rhythm ◽  
Hospital Variation ◽  
Hospital Cardiac Arrest

Background: For patients with in-hospital cardiac arrests due to non-shockable rhythms, delays in epinephrine administration beyond 5 minutes is associated with worse survival. However, the extent of hospital variation in delayed epinephrine administration and its impact on hospital-level outcomes is unknown. Methods: Within Get with the Guidelines-Resuscitation, we identified 103,932 adult patients (>18 years) at 548 hospitals with an in-hospital cardiac arrest due to a non-shockable rhythm who received at least 1 dose of epinephrine between 2000 to 2014. We constructed two-level hierarchical regression models to quantify hospital variation in rates of delayed epinephrine administration (>5 minutes) and its association with hospital rates of survival to discharge. Results: Among the 548 hospitals, there was substantial variation in rates of delayed epinephrine administration (median 13.5%, range: 0%- 53.8%). The odds of delay in epinephrine administration were 61% higher at one randomly selected hospital compared to a similar patient at another randomly selected hospitals (median odds ratio [OR] 1.61; 95% C.I. 1.54 - 1.67). After adjusting for patient characteristics, the median risk-standardized survival rate for non-shockable in-hospital cardiac arrests was 12.1% and varied significantly across hospitals (range: 5.2% to 30.9%). There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized survival rate for cardiac arrests due to non-shockable rhythm (ρ= -0.23, P<0.0001). Compared to hospitals in the best quartile, risk-standardized survival was 17.4% lower at hospitals in the worst quartile of delayed epinephrine administration (13.8% vs. 11.4%, P<0.0001, Figure). Conclusions: Although delays in epinephrine administration following in-hospital cardiac arrest are common, there is substantial hospital variation in rates of delayed epinephrine administration. Hospitals with high rates of delayed epinephrine administration were found to have lower rates of risk-adjusted survival. Further studies are needed to determine if improving hospital performance on time to epinephrine administration, especially at hospitals with poor performance on this metric will lead to improvement in outcomes.

scholarly journals Prehospital cardiopulmonary resuscitation duration and neurological outcome after adult out-of-hospital cardiac arrest by location of arrest

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S90-S99
Author(s):  
Takefumi Kishimori ◽  
Tasuku Matsuyama ◽  
Kosuke Kiyohara ◽  
Tetsuhisa Kitamura ◽  
Haruka Shida ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Service ◽  
Neurological Outcome ◽  
Medical Service ◽  
Regression Analyses ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Background Little is known about the association between prehospital cardiopulmonary resuscitation duration for adults with out-of-hospital cardiac arrest and outcome by the location of arrests. This study aimed to investigate the association between prehospital cardiopulmonary resuscitation duration and one-month survival with favourable neurological outcome. Methods We analysed 276,391 adults aged 18 years and older with out-of-hospital cardiac arrest of medical origin before emergency medical service arrival. Prehospital cardiopulmonary resuscitation duration was defined as the time from emergency medical service-initiated cardiopulmonary resuscitation to prehospital return of spontaneous circulation or to hospital arrival. The primary outcome was one-month survival with favourable neurological outcome (cerebral performance category 1 or 2). The association between prehospital cardiopulmonary resuscitation duration and favourable neurological outcome was assessed using univariable and multivariable logistic regression analyses. Results The proportion of favourable neurological outcomes was 2.3% in total, 7.6% in public locations, 1.5% in residential locations and 0.7% in nursing homes ( P < 0.001). In univariable and multivariable logistic regression analyses, longer prehospital cardiopulmonary resuscitation duration was associated with poor neurological outcome, regardless of arrest location ( P for trend < 0.001). Patients with shockable rhythm in both public and residential locations had better neurological outcome than those in nursing homes at any time point, and residential and public locations had a similar neurological outcome tendency among patients with shockable rhythm. Conclusions Longer prehospital cardiopulmonary resuscitation duration was independently associated with a lower proportion of patients with favourable neurological outcomes. Moreover, the association between prehospital cardiopulmonary resuscitation duration and neurological outcome differed according to the location of arrest and the first documented rhythm.

scholarly journals Survival analysis in out-of-hospital cardiac arrest patients with shockable rhythm directly transport to Heart Centers

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Survival Analysis ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Transport Time ◽  
Neurological Outcomes ◽  
Neurologic Outcomes ◽  
Shockable Rhythm ◽  
Short Time ◽  
Hospital Cardiac Arrest

Background: This study aimed to evaluate whether out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythm without prehospital return of spontaneous circulation (ROSC) who are directly transported to Heart Centers in appropriate time will have better post-cardiac arrest four months survival and neurological outcomes at discharge. Methods: This retrospective study assessed the data of 1,588 OHCA patients with shockable rhythm and without prehospital ROSC collected from the registry database of Taoyuan City between January 2014 and June 2018. The relationships of transport time to Heart Centers with survival at discharge and with neurological outcomes were investigated for survival analysis. Results: Among the 1,588 OHCA patients with initial shockable rhythm and without prehospital ROSC, 1,222 (77.0%) and 366 (23.0%) were transported to Heart Centers and non-Heart Centers, respectively. However, the transport to Heart Centers was associated with an increased survival at discharge (adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI], 1.42–2.81) and good neurological outcomes (cerebral performance category [CPC] 1 and 2) (aOR 3.14, 95% CI, 1.88–5.23), regardless of the transport time. The overall mortality reduction for Heart Centers was 39% (hazard ratio [HR] = 0.61; 95% CI 0.47–0.78), compared to that for non-Heart Centers. At 120 days of follow-up, the results showed a higher survival rate for patients who were transported to Heart Centers within a short time. The percentages of good CPC showed a better distribution for non-Heart Centers versus those for Heart Centers. Conclusions: Adult OHCA patients with initial shockable rhythm and without prehospital ROSC who were transported to Heart Centers directly had better post-cardiac arrest survival and good neurologic outcomes, regardless of the transport time.

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.

scholarly journals Survival rate of incoming patients with cardiac arrest at the cardiology infirmary of the emergency department of a public hospital in Greece

2019 ◽  
Vol 5 (2) ◽  
pp. 53
Author(s):  
Styliani Papadopoulou ◽  
Olympia Konstantakopoulou ◽  
Antonia Kalogianni ◽  
Martha Kelesi-Stavropoulou ◽  
Theodore Kapadohos
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Survival Rate ◽  
Emergency Room ◽  
Survival Rates ◽  
Public Health Problem ◽  
Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Discharged Patients ◽  
Hospital Cardiac Arrest

Introduction: Cardiac arrest is an urgent situation that, despite the improved resuscitation capabilities, the survival rate of out-of-hospital cardiac arrest victims remains low.Aim: Τo investigate the survival rate of the incoming patients with cardiac arrest in the cardiology infirmary of the emergency department of a public hospital.Material-Method: The study included 210 patients who were transferred pulseless and breathless at the cardiology infirmary of the emergency department of “Tzaneio” Hospital, Piraeus, during the period April 2017 - November 2018. Data was collected from the National Center of Emergency Dispatch's printed forms, as well as from the patients’ admission book of the emergency department.Results: More than 10% (11.9%) of patients with cardiac arrest returned to spontaneous circulation in the emergency department, of which 16% was discharged. Patients with known cardiac history, (p=0.002), with a shockable rhythm (p<0.001), and especially ventricular fibrillation (p<0.001) upon arrival at the emergency room, and patients who were defibrillated at the ambulance during admission and at the emergency room, were more likely to survive (p<0.001). No statistically significant correlation was found between the factors studied and survival after cardiac arrest, in the group of patients that were discharged.Conclusions: The survival rate of the incoming patients with cardiac arrest at the emergency department of “Tzaneio” Hospital, Piraeus, was low. As for most health systems, this issue constitutes a fairly complex public health problem. Cardiopulmonary resuscitation and corresponding guidelines require further improvement in order for the survival rates of out-of-hospital cardiac arrest patients to increase.

Abstract 14171: Prehospital Outcomes and Patient Characteristics Associated With PulsePoint Dispatches for Out-of-Hospital Cardiac Arrest in Pittsburgh, Pennsylvania

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
David Salcido ◽  
Christian Martin-Gill ◽  
LEONARD WEISS ◽  
David D Salcido
Keyword(s):  
Cardiac Arrest ◽  
Response Time ◽  
Statistical Significance ◽  
Patient Characteristics ◽  
The United States ◽  
Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Bystander Cpr ◽  
Case Characteristics ◽  
Hospital Cardiac Arrest

Background: Mobile phone-based dispatch of volunteers to out-of-hospital cardiac arrest (OHCA) has been shown to increase the likelihood of early chest compressions and AED application. In the United States, limited characterization of patients encountered as a result of such systems exists, including PulsePoint Respond, a smartphone-based volunteer dispatch system. Objective: Examine prehospital case characteristics and outcomes from a multi-year deployment of PulsePoint in Pittsburgh, Pennsylvania. Methods: Case data, including PulsePoint determinant triggers and timing, prehospital electronic health records (EHRs), and computer aided dispatch records were obtained for suspected EMS-treated OHCA cases that did and did not generate PulsePoint alerts within the service area of Pittsburgh EMS for the period July 2016 to October 2020. EHRs were reviewed to determine true OHCA status, and OHCA case characteristics were extracted according to the Utstein template. Key characteristics and the outcome of prehospital return of spontaneous circulation (ROSC) were summarized and compared between cases with and without PulsePoint dispatches. Chi-squared tests were used to determine statistical significance of relationships. Results: There were 1229 OHCA cases overall in the capture period, with an estimated 29.6% occurring in public. Of 840 total PulsePoint dispatches, 68 (8.1%) were for true OHCA. Forty-five (66.2%) of these were witnessed, 43 (63.2%) received bystander CPR, and 17 (25%) had an AED applied prior to first responder arrival. Twenty-seven (39.7%) had an initial shockable rhythm, and 34 (50%) achieved ROSC in the field. Compared to non-PulsePoint dispatch generating OHCA, PulsePoint alert-associated patients were significantly more likely to be male (p=0.024), have bystander CPR/AED application performed (p<0.001), have an initial shockable rhythm (p<0.001), and achieve ROSC (p<0.001). EMS response time, age, ALS response time, and witnessed status were not significantly different. Conclusions: A minority of PulsePoint dispatches in Pittsburgh were triggered by true OHCA. Among cases that did generate a PulsePoint dispatch, case characteristics were prognostically favorable.

Abstract 206: Neurological Outcomes and the Time From Collapse to the Initiation of Extracorporeal Membrance Oxygenation in Patients With Out-Of-Hospital and In-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Takashi Unoki ◽  
Daisuke Takagi ◽  
Tomoko Nakayama ◽  
Yudai Tamura ◽  
Megumi Yamamuro ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Receiver Operating Curve ◽  
Optimal Timing ◽  
Neurological Outcomes ◽  
Coronary Syndrome ◽  
Good Outcome ◽  
Shockable Rhythm ◽  
Outcome Group ◽  
Hospital Cardiac Arrest ◽  
Refractory Cardiac Arrest

Background: Encouraging results of extracorporeal cardiopulmonary resuscitation (E-CPR) for patients with refractory cardiac arrest have been shown. However, an optimal timing to switch from conventional CPR to E-CPR are not well established. To determine the optimal timing when E-CPR should be performed, we investigated the relationship between the time from collapse to the initiation of extracorporeal membrane oxygenation (Collapse-to-ECMO time ) and neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) treated with E-CPR. Methods: A total of 80 consecutive patients (age 64±16 years, male ratio 76%, shockable rhythm 48%, and OHCA 51%) received E-CPR between January 2012 and May 2019. The primary endpoint was survival with good neurological outcomes at hospital discharge (a cerebral performance category of 1 or 2). Results: Of the 80 patients included, 8 had good neurological outcomes. The rate of male was significantly higher in the good outcome group compared with the non-good outcome group. There was no significant difference in the age and the rates of initial shockable rhythm and acute coronary syndrome between the two groups. IHCA had the better outcomes compared with OHCA, but the difference does not reach significance [15.4% (6 of 39) vs. 4.9% (2 of 41); P=0.1]. The median Collapse-to-ECMO time was significantly shorter in the good outcome group compared with the non-good outcome group (38.5 min, interquartile range [IQR], 19.3-54.5 vs. 58.5 min, IQR, 35.3-76.0: p = 0.04). The area under the receiver operating curve of the Collapse-to-ECMO time for predicting a good neurological outcome was 0.72, and the optimal cutoff time was 60 min. Stepwise multivariate logistic regression analysis including data on age, sex, shockable rhythm, OHCA, and the Collapse-to-ECMO time under 60 min revealed that a male sex (P=0.03), shockable rhythm (P=0.03) and the Collapse-to-ECMO time under 60 min (P<0.001) were significantly associated with the good outcome. Conclusions: The Collapse-to-ECMO time was independently associated with good neurological outcomes. In patients with refractory cardiac arrest, it may be considered to initiate E-CPR within 60 min from collapse regardless of OHCA or IHCA.

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