Relationship between duration of prehospital resuscitation and favorable prognosis in ventricular fibrillation

Funada

2016

JAHA

137

103

Background--The determination of appropriate duration of in-the-field cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients is one of the biggest challenges for emergency medical service providers and clinicians. The appropriate CPR duration before termination of resuscitation remains unclear and may differ based on initial rhythm. We aimed to determine the relationship between CPR duration and post-OHCA outcomes.

Section: Discussionmentioning

confidence: 99%

Relationship Between the Duration of Cardiopulmonary Resuscitation and Favorable Neurological Outcomes After Out‐of‐Hospital Cardiac Arrest: A Prospective, Nationwide, Population‐Based Cohort Study

Funada

2016

JAHA

137

103

“…Several studies have investigated the influence of CPR duration on survival or neurological outcomes in OHCA patients [5, 6, 11, 12, 27]. Previous studies have reported that a pre-hospital CPR duration of 26–48 min achieves a 99% cumulative proportion for neurologically favorable outcomes [5, 6, 11, 12]. In addition, the probability of survival rapidly decreases with each minute of CPR [27].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, estimating the critical CPR duration must include consideration of pre- and in-hospital settings. Moreover, while many previous studies adjusted for pre-hospital confounders, in-hospital factors were left unadjusted [5, 6, 11, 12]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2017

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.

The Journal of Critical Care Medicine

“…In another study, the increase in prehospital duration of CPR was associated with adverse outcomes despite the introduction of ECPR, indicating that transportation to a more definitive treatment facility should be preferred rather than pre-hospital initiation of ECPR in cases with an extended CPR duration [68]. …”

Section: Systems Of Care For Cardiac Arrest Following Acute Myocardiamentioning

confidence: 99%

Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

Benedek

Glogar

2016

This review summarizes the most recent developments in providing advanced supportive measures for cardiopulmonary resuscitation, and the results obtained using these new therapies in patients with cardiac arrest caused by acute myocardial infarction (AMI). Also detailed are new approaches such as extracorporeal cardiopulmonary resuscitation (ECPR), intra-arrest percutaneous coronary intervention, or the regional models for systems of care aiming to reduce the critical times from cardiac arrest to initiation of ECPR and coronary revascularization.