Prehospital cardiopulmonary resuscitation duration and neurological outcome after out-of-hospital cardiac arrest among children by location of arrest: a Nationwide cohort study

Abstract

Background Little is known about the associations between the duration of prehospital cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) and outcomes among paediatric patients with out-of-hospital cardiac arrests (OHCAs). We investigated these associations and the optimal prehospital EMS CPR duration by the location of arrests. Methods We included paediatric patients aged 0–17 years with OHCAs before EMS arrival who were transported to medical institutions after resuscitation by bystanders or EMS personnel. We excluded paediatric OHCA patients for whom CPR was not performed, who had cardiac arrest after EMS arrival, whose EMS CPR duration were < 0 min or ≥120 min and who had cardiac arrest in healthcare facilities. Prehospital EMS CPR duration was defined as the time from CPR initiation by EMS personnel to the time of prehospital return of spontaneous circulation or to the time of hospital arrival. The primary outcome was 1-month survival with a favourable neurological outcome (cerebral performance category scale 1 or 2). Statistical analysis was performed with Mann-Whitney U tests for numerical variables and chi-squared test for categorical variables. Univariable and multivariable logistic regression analyses were applied to assess the association between prehospital EMS CPR duration and a favourable neurological outcome, and crude and adjusted odds ratios and their 95% confidence intervals were calculated. Results The proportion of patients with a favourable neurological outcome was lower in residential locations than in public locations (2.3% [66/2865] vs 10.8% [113/1048]; P < .001). In both univariable and multivariable logistic regression analyses, the proportion of patients with a favourable neurological outcome decreased as prehospital EMS CPR duration increased, regardless of the location of arrests ( P for trend <.001). However, some patients achieved a favourable neurological outcome after a prolonged prehospital EMS CPR duration (> 30 min) in both groups (1.4% [6/417] in residential locations and 0.6% [1/170] in public locations). Conclusions A longer prehospital EMS CPR duration is independently associated with a lower proportion of patients with a favourable neurological outcome. The association between prehospital EMS CPR duration and neurological outcome differed significantly by location of arrests.

Patient outcomes of school‐age, out‐of‐hospital cardiac arrest in Japan: A nationwide study of schoolchildren as witnesses

“…20 As a result, CPR education and widespread AED installation have occurred, resulting in a higher proportion of bystander interventions. 21 The present study suggests that schoolchildren could contribute to improving outcomes in OHCA. Therefore, adding BLS training in school curricula is beneficial and should be valued in school education.…”

“…A study in Denmark has reported that educating schoolchildren on CPR is associated with an increase in lay CPR rates and survival following OHCA; the survival rate of OHCA has increased significantly since BLS education became mandatory for schoolchildren 19 . In 2015, the Japan Circulation Society published the statement “Aiming for Zero Deaths: Prevention of Sudden Cardiac Death in Schools and Sport Locations.” 20 As a result, CPR education and widespread AED installation have occurred, resulting in a higher proportion of bystander interventions 21 . The present study suggests that schoolchildren could contribute to improving outcomes in OHCA.…”

Successful Recovery After Prolonged Cardiopulmonary Resuscitation and Rescue Thrombolytics in a Patient with Cardiac Arrest Secondary to Presumed Massive Pulmonary Embolism

“…6,7 Some studies from case report and case series showed that prolonged CPR, especially in combination with the utility of extracorporeal membrane oxygenation has meaningful survival rates and the survivors are able to regain favorable neurological outcome and return to normal life. [8][9][10][11][12] However, successful recovery after extremely long CPR with manual chest compressions, as in our case, has rarely been reported. 8,13 Our case suggested that prolonged resuscitation is not futile although it poses a real challenge for doctors with uncertain outcomes.…”

The Impact of Emergency Interventions and Patient Characteristics on the Risk of Heart Failure in Patients with Nontraumatic OHCA

“…Finally, prehospital information did not include in this database. Although the associations between prehospital interventions and postresuscitation heart functions had not been clearly addressed, some previous studies pointed out that bystander CPR, public defibrillation were strong predictors of survival (even good neurologic outcome) [37,38].…”