Duration of conventional cardiopulmonary resuscitation prior to extracorporeal cardiopulmonary resuscitation and survival among adult cardiac arrest patients.

Mosca, Matthew S.; Narotsky, David L.; Mochari‐Greenberger, Heidi; Liao, Ming; Mongero, Linda B.; Beck, Jürgen; Bacchetta, Matthew

doi:10.1177/0267659115589399

Cited by 8 publications

(2 citation statements)

References 17 publications

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“…In advanced therapies, such as extracorporeal assisted CPR, CPR duration should be considered as a component of the protocol [4, 27, 29, 30]. For example, Reynolds et al showed that the optimal time for considering an alternative method to conventional CPR is within 15 min [27].…”

Section: Discussionmentioning

confidence: 99%

Association between cardiopulmonary resuscitation duration and one-month neurological outcomes for out-of-hospital cardiac arrest: a prospective cohort study

et al. 2017

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BackgroundThe duration of cardiopulmonary resuscitation (CPR) is an important factor associated with the outcomes for an out-of-hospital cardiac arrest. However, the appropriate CPR duration remains unclear considering pre- and in-hospital settings. The present study aimed to evaluate the relationship between the CPR duration (including both the pre- and in-hospital duration) and neurologically favorable outcomes 1-month after cardiac arrest.MethodsData were utilized from a prospective multi-center cohort study of out-of-hospital cardiac arrest patients transported to 67 emergency hospitals between January 2012 and March 2013 in the Kanto area of Japan. A total of 3,353 patients with out-of-hospital cardiac arrest (age ≥18 years) who underwent CPR by emergency medical service personnel and achieved the return of spontaneous circulation in a pre- or in-hospital setting were analyzed. The primary outcome was a 1-month favorable neurological outcome. Logistic regression analysis was performed to estimate the influence of cardiopulmonary resuscitation duration. The CPR duration that achieved a cumulative proportion >99% of cases with a 1-month neurologically favorable outcome was determined.ResultsOf the 3,353 eligible cases, pre-hospital return of spontaneous circulation was obtained in 1,692 cases (50.5%). A total of 279 (8.3%) cases had a 1-month neurologically favorable outcome. The CPR duration was significantly and inversely associated with 1-month neurologically favorable outcomes with adjustment for pre- and in-hospital confounders (adjusted odds ratio: 0.911, per minute, 95% CI: 0.892–0.929, p < 0.001). After 30 min of CPR, the probability of a 1-month neurologically favorable outcome decreased from 8.3 to 0.7%. At 45 min of CPR, the cumulative proportion for a 1-month neurologically favorable outcome reached >99%.ConclusionsThe CPR duration was independently and inversely associated with 1-month neurologically favorable outcomes after out-of-hospital cardiac arrest. The CPR duration required to achieve return of spontaneous circulation in >99% of out-of-hospital cardiac arrest patients with a 1-month favorable neurological outcome was 45 min, considering both pre- and in-hospital settings.

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Section: Discussionmentioning

confidence: 99%

Association between cardiopulmonary resuscitation duration and one-month neurological outcomes for out-of-hospital cardiac arrest: a prospective cohort study

et al. 2017

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“…Nevertheless, when CCPR is prolonged, even if adequately delivered, the probability of return of spontaneous circulation (ROSC) progressively decreases. In one study, Mosca et al reported that CPR maneuvers lasting for more than 45 min were associated with hospital survival of less than 2%, most of the patients dying without achieving ROSC [4]. In this setting, in particular for patients who have received the best possible resuscitation (i.e., short no-flow time, bystander CPR, shockable rhythms refractory to defibrillation), there would be a high possibility of good cardiac and neurological recovery in case of ROSC, which make these patients as the best potential candidates for extracorporeal cardiopulmonary resuscitation (ECPR).…”

Section: Introductionmentioning

confidence: 99%

Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study

et al. 2019

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BackgroundThe potential benefit of extracorporeal cardiopulmonary resuscitation (ECPR) compared to conventional CPR (CCPR) for patients with refractory cardiac arrest (CA) remains unclear.MethodsThis study is a retrospective analysis of a prospective database of CA patients, which includes all consecutive adult patients admitted to the Department of Intensive Care after CA between January 2012 and December 2017. The decision to initiate ECPR was made by the attending physician and ECPR performed by the ECPR team, which is composed of ICU physicians. A propensity score was derived using a logistic regression model, including characteristics that varied between groups with a p < 0.10 and were potentially related to outcome. Primary outcomes were survival to ICU discharge and favorable 3-month neurologic outcome, assessed by a Cerebral Performance Category (CPC) score of 1–2.ResultsFrom a total of 635 patients with CA during the study period (ECPR, n = 112), 80 ECPR patients were matched to 80 CCPR patients. The time from arrest to termination of CPR (i.e., return of spontaneous circulation [ROSC], extracorporeal membrane oxygenation [ECMO] initiation, or death) was 54 ± 22 and 54 ± 19 min in the ECPR and CCPR groups, respectively. ROSC rates were 77/80 (96%) for ECPR and 30/80 (38%) for CCPR (p < 0.001). Survival to ICU discharge was 18/80 (23%) vs. 14/80 (18%) in the ECPR and CCPR groups, respectively (p = 0.42). At 3 months, 17/80 (21%) ECPR patients and 9/80 (11%) CCPR patients had a favorable outcome (p = 0.11). Cox regression analysis stratified by matched pairs showed a significantly higher neurologic outcome rate in the ECPR group than in the CCPR group (log-rank test p = 0.003).ConclusionsECPR after CA may be associated with improved long-term neurological outcome.

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Extracorporeal Membrane Oxygenation in the Emergency Department for Out-of-Hospital Cardiac Arrest

Meurer

Kaplan

2022

The Journal of Emergency Medicine

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Duration of conventional cardiopulmonary resuscitation prior to extracorporeal cardiopulmonary resuscitation and survival among adult cardiac arrest patients.

Abstract: More than half of all patients who received ECPR survived to 30 days. Longer duration CCPR was associated with reduced survival within 2 weeks, but not at 30 days.

Cited by 8 publications

References 17 publications

Association between cardiopulmonary resuscitation duration and one-month neurological outcomes for out-of-hospital cardiac arrest: a prospective cohort study

Association between cardiopulmonary resuscitation duration and one-month neurological outcomes for out-of-hospital cardiac arrest: a prospective cohort study

Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study

Extracorporeal Membrane Oxygenation in the Emergency Department for Out-of-Hospital Cardiac Arrest

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