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Prehospital Resuscitation After Cardiac Arrest
Study Questions:
How long should prehospital resuscitation efforts be continued during out-of-hospital cardiac arrest (OHCA)?
Methods:
Between 2005 and 2012, the authors enrolled 282,183 adult patients with bystander-witnessed OHCA through the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation (ROSC) in cases achieving prehospital ROSC or from call receipt to hospital arrival in cases not achieving prehospital ROSC. In each of four groups stratified by initial cardiac arrest rhythm (shockable vs. nonshockable) and bystander resuscitation (presence vs. absence), they calculated minimum prehospital resuscitation duration, defined as the length of resuscitation efforts in minutes required to achieve ≥99% sensitivity for the primary endpoint, favorable 30-day neurological outcomes after OHCA.
Results:
Prehospital resuscitation duration to achieve prehospital ROSC ranged from 1 to 60 minutes. Longer prehospital resuscitation duration reduced the likelihood of favorable neurological outcomes. Although the frequency of favorable neurological outcome was significantly different between the four groups, ranging from 20.0% (shockable/bystander resuscitation group) to 0.9% (nonshockable/bystander resuscitation group) (p < 0.001), minimum prehospital resuscitation duration did not differ widely between the four groups (40 minutes in the shockable/bystander resuscitation group and the shockable/no bystander resuscitation group, 44 minutes in the nonshockable/bystander resuscitation group, and 45 minutes in the nonshockable/no bystander group).
Conclusions:
Based on time intervals from the shockable arrest groups, prehospital resuscitation efforts should be continued for at least 40 minutes in all adults with bystander-witnessed OHCA.
Perspective:
Despite advances in resuscitation care, overall survival after OHCA remains very poor. The optimal duration of resuscitation is unknown, but the current report suggests that it should last at least 40 minutes or longer from call receipt in all adult patients with bystander-witnessed OHCA. This contrasts with prior recommendations of continuing resuscitation for only 20-30 minutes from the National Association of EMS Physicians Standards and Clinical Practice Committee in 2000. It is possible that the improvement in the resuscitation care since then has extended the period of time with neurologically intact survival.
Keywords: Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Heart Arrest, Out-of-Hospital Cardiac Arrest, Resuscitation, Secondary Prevention, Shock, Survival, Treatment Outcome
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