Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac Arrest: When Should We Change to Novel Therapies?
What is the relationship between the duration of cardiopulmonary resuscitation (CPR) until return of spontaneous circulation (ROSC) and outcomes in patients with out-of-hospital cardiac arrest (OHCA)?
In this retrospective study, 1,014 patients (mean age 65 years) with OHCA were identified from a cardiac arrest database. The primary endpoint was survival to hospital discharge with good functional status.
ROSC occurred in 47% of patients. Survival to hospital discharge was 11%, and 6% of patients had good functional status at the time of discharge. Among the patients with good functional status, 74.1% had achieved ROSC within the first 9.3 minutes of CPR and 89.7% had done so within 16.1 minutes of CPR. CPR duration was independently inversely associated with survival to hospital discharge with good functional status (odds ratio, 0.84).
The odds of survival with good functional status in patients with OHCA decline with every minute of CPR. Good functional status is very unlikely if ROSC has not occurred within approximately 10-15 minutes of CPR.
The authors’ point is a good one—if conventional CPR measures have not resulted in ROSC early on in the resuscitation effort, simply repeating the same measures (e.g., manual chest compression, defibrillation, epinephrine administration) is unlikely to improve the odds of survival with favorable neurological status. The implication of their findings is that novel approaches to resuscitation of patients with OHCA, such as extracorporeal life support, should be instituted immediately if they are to have any impact on meaningful survival.
Keywords: Out-of-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation
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