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

BMC Anesthesiology

Research Article

Naohiro Yonemoto¹  Yoshio Tahara²  Atsushi Sakurai³  Ken Nagao⁴  Yuichi Hamabe⁵  Masahiro Kashiura⁵  Akiko Akashi⁵  Arino Yaguchi⁶  Naoto Morimura⁷ 

[1] Kyoto University School of Public Health, Kyoto, Japan;National Cerebral and Cardiovascular Center Hospital, Osaka, Japan;Nihon University School of Medicine, Tokyo, Japan;Nihon University Surugadai Hospital, Tokyo, Japan;Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, 130-8575, Tokyo, Japan;Tokyo Women’s Medical University Hospital, Tokyo, Japan;Yokohama City University Medical Center, Kanagawa, Japan;

关键词: Cardiopulmonary resuscitation;    Emergency medical services;    Out-of-hospital cardiac arrest;    Patient outcome assessment;   

DOI  :  10.1186/s12871-017-0351-1

 received in 2017-01-22, accepted in 2017-04-13,  发布年份 2017

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© The Author(s). 2017