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

Reynolds, Joshua C.; Grunau, Brian; Rittenberger, Jon C.; Sawyer, Kelly N.; Kurz, Michael C.; Callaway, Clifton W.

doi:10.1161/circulationaha.116.023309

Cited by 195 publications

(124 citation statements)

References 37 publications

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“…These data do not address the possibility of combining sodium bicarbonate along with extracorporeal membrane support or administration earlier in the resuscitation. We have previously reported most favorable outcomes are achieved with shorter resuscitation intervals (22,23).…”

Section: Discussionmentioning

confidence: 91%

Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study

Kim

Sohn

et al. 2018

J. Thorac. Dis.

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Background: Sodium bicarbonate administration during cardiopulmonary resuscitation (CPR) is controversial. Current guidelines recommend sodium bicarbonate injection in patients with existing metabolic acidosis, but clinical trials, particularly, those involving patients with acidosis, are limited. We aimed to evaluate the efficacy of sodium bicarbonate administration in out-of-hospital cardiac arrest (OHCA) patients with severe metabolic acidosis during prolonged CPR. Methods: Prospective, double-blind, randomized placebo-controlled pilot trial was conducted between January 2015 and December 2015, at a single center emergency department (ED). After 10 minutes of CPR, patients who failed to achieve return of spontaneous circulation (ROSC) and with severe metabolic acidosis (pH<7.1 or bicarbonate <10 mEq/L) were enrolled. Sodium bicarbonate (n=25) or normal saline (n=25) were administered. The primary end point was sustained ROSC. The secondary end points were the change of acidosis and good neurologic survival. Results: Sodium bicarbonate group had significant effect on pH (6.99 vs. 6.90, P=0.038) and bicarbonate levels (21.0 vs. 8.0 mEq/L, P=0.007). However, no significant differences showed between sodium bicarbonate and placebo groups in sustained ROSC (4.0% vs. 16.0%, P=0.349) or good neurologic survival at 1 month (0.0% vs. 4.0%, P=1.000). Conclusions: The use of sodium bicarbonate improved acid-base status, but did not improve the rate of ROSC and good neurologic survival. We could not draw a conclusion, but our pilot data could be used to design a larger trial to verify the efficacy of sodium bicarbonate.Trial Registration: NCT02303548 (http://www.ClinicalTrials.gov).

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Section: Discussionmentioning

confidence: 91%

Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study

Kim

Sohn

et al. 2018

J. Thorac. Dis.

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“…6-8, 11 In these studies, patients with non-shockable rhythms were older than those with shockable rhythms. In the present study, the proportion of nonshockable rhythm increased with age.…”

Section: -11mentioning

confidence: 85%

“…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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“…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). There were no survivors with favourable neurological outcome where ROSC occurred after 47 minutes.…”

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

confidence: 99%

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

Cited by 195 publications

References 37 publications

Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study

Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study

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

Out-of-hospital cardiac arrest: prehospital management

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