Impact of cardiopulmonary resuscitation duration on neurologically favourable outcome after out-of-hospital cardiac arrest: A population-based study in Japan.

The optimal cardiopulmonary resuscitation (CPR) duration for patients with out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to assess the association between CPR duration and outcome after OHCA. This prospective, population-based observational study conducted in Osaka, Japan enrolled 6981 adult patients with non-traumatic witnessed OHCA who achieved return of spontaneous circulation (ROSC) from January 2005 through December 2012. CPR duration was defined as the time of CPR initiation by emergency medical service personnel to the ROSC in pre-hospital settings or after hospital admission. The primary outcome was one-month survival with neurologically favourable outcome (cerebral performance category scale 1 or 2). Overall, median CPR duration was 25min (interquartile range: 15-34) and the proportion of neurologically favourable outcome was 12.5% (875/6,981). The proportion of neurologically favourable outcome among the CPR duration ≥31min group was significantly lower compared with that among the 0-5min group (55.1% [320/581] versus 2.2% [54/2424], adjusted odds ratio [AOR] 0.04; 95% confidence interval [CI] 0.03-0.05 in all patients, 78.4% [240/306] versus 11.4% [30/264], AOR 0.04; 95% CI 0.02-0.06 in the shockable group, 29.1% [80/275] versus 1.1% [24/2160], and AOR 0.03; 95% CI 0.02-0.05 in the non-shockable group). The cumulative proportion for neurologically favourable outcome reached 99% after 44, 41, and 43min of CPR in all patients, the shockable group, and the non-shockable group, respectively. The proportion of patients with neurologically favourable outcome declined with increasing CPR duration, but some OHCA patients could benefit from prolonged CPR duration >30min.

Matsuyama T ，Kitamura T ，Kiyohara K ，Nishiyama C ，Nishiuchi T ，Hayashi Y ，Kawamura T ，Ohta B ，Iwami T ... -  《-》

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

Kashiura M ，Hamabe Y ，Akashi A ，Sakurai A ，Tahara Y ，Yonemoto N ，Nagao K ，Yaguchi A ，Morimura N ，SOS-KANTO 2012 Study Group ... -  《BMC Anesthesiology》

Duration of cardiopulmonary resuscitation in patients without prehospital return of spontaneous circulation after out-of-hospital cardiac arrest: Results from a severity stratification analysis.

The relationship between duration of cardiopulmonary resuscitation (CPR) and post-arrest outcomes based on severity stratification in out-of-hospital cardiac arrest (OHCA) patients without prehospital return of spontaneous circulation (ROSC) remains unclear. We analysed 420,959 adult patients without prehospital ROSC in the All-Japan OHCA registry for 4 years. Prehospital CPR duration was defined as the time from CPR initiation by emergency medical service (EMS) providers to hospital arrival. The primary outcome was 1-month neurologically intact survival (cerebral performance category 1 or 2, CPC 1-2). The rate of overall 1-month CPC 1-2 was 0.45% (1899/420,959). Using recursive partitioning analysis to predict 1-month CPC 1-2, we stratified patients into 4 groups with 3 predictors: patients aged <75 years with initial shockable rhythm (1-month CPC 1-2 rate, 6.15%), those aged ≥75 years with initial shockable rhythm (1.32%), those with EMS-witnessed arrest and initial non-shockable rhythm (1.62%), and those with EMS-unwitnessed arrest and initial non-shockable rhythm (0.15%). Prehospital CPR duration was negatively associated with 1-month CPC 1-2 (adjusted odds ratio 0.94 per 1-min increment; 95% confidence interval 0.94-0.95). Prehospital CPR durations beyond which the dynamic probability of 1-month CPC 1-2 decreased to <1% were 26 min, 10 min, 7 min, and at all times in above-mentioned stratification, respectively. In OHCA patients without prehospital ROSC, those aged <75 years with initial shockable rhythm had acceptable 1-month CPC 1-2 rate. However, CPR efforts lasting 26 min or over before hospital arrival could be futile.

Funada A ，Goto Y ，Tada H ，Teramoto R ，Shimojima M ，Hayashi K ，Kawashiri MA ，Yamagishi M ... -  《-》

Effects of prehospital epinephrine administration on neurologically intact survival in bystander-witnessed out-of-hospital cardiac arrest patients with non-shockable rhythm depend on prehospital cardiopulmonary resuscitation duration required to hospital

Funada A ，Goto Y ，Tada H ，Shimojima M ，Hayashi K ，Kawashiri MA ，Yamagishi M ... -  《-》

The response time threshold for predicting favourable neurological outcomes in patients with bystander-witnessed out-of-hospital cardiac arrest.

It is well established that the period of time between a call being made to emergency medical services (EMS) and the time at which the EMS arrive at the scene (i.e. the response time) affects survival outcomes in patients who experience out-of-hospital cardiac arrest (OHCA). However, the relationship between the response time and favourable neurological outcomes remains unclear. We therefore aimed to determine a response time threshold in patients with bystander-witnessed OHCA that is associated with positive neurological outcomes and to assess the relationship between the response time and neurological outcomes in patients with OHCA. This study was a retrospective, observational analysis of data from 204,277 episodes of bystander-witnessed OHCA between 2006 and 2012 in Japan. We used classification and regression trees (CARTs) and receiver operating characteristic (ROC) curve analyses to determine the threshold of response time associated with favourable neurological outcomes (Cerebral Performance Category 1 or 2) 1 month after cardiac arrest. Both CARTs and ROC analyses indicated that a threshold of 6.5min was associated with improved neurological outcomes in all bystander-witnessed OHCA events of cardiac origin. Furthermore, bystander cardiopulmonary resuscitation (CPR) prolonged the threshold of response time by 1min (up to 7.5min). The adjusted odds ratio for favourable neurological outcomes in patients with OHCA who received care within ≤6.5min was 1.935 (95% confidential interval: 1.834-2.041, P<0.001). A response time of ≤6.5min was closely associated with favourable neurological outcomes in all bystander-witnessed patients with OHCA. Bystander CPR prolonged the response time threshold by 1min.

Ono Y ，Hayakawa M ，Iijima H ，Maekawa K ，Kodate A ，Sadamoto Y ，Mizugaki A ，Murakami H ，Katabami K ，Sawamura A ，Gando S ... -  《-》