Relationship between cardiopulmonary resuscitation duration and outcomes in children with drowning-induced cardiac arrest.

Due to the difficulty in making the decision to discontinue resuscitation efforts, clinicians often perform prolonged cardiopulmonary resuscitation (CPR) in children who have drowned. This study investigated the relationship between out-of-hospital CPR duration and neurological outcomes in children with drowning-induced cardiac arrest. This retrospective cohort study used data from the All-Japan Utstein Registry from 2013 to 2021. We included patients aged ≤18 years with drowning-induced cardiac arrest who underwent CPR via emergency medical services. The study's primary outcome was a favorable neurological outcome (Cerebral Performance Category score of 1 or 2) at 1 month. We also calculated the dynamic proportion of 1-month outcomes as a function of out-of-hospital CPR duration. Moreover, we determined the sensitivity, specificity, and positive predictive value of 33 min of out-of-hospital CPR, which is the time point at which primary analysis showed a plateau in the neurological outcomes. Of 14,849 children included in the registry, 992 cases of drowning-induced cardiac arrest were analyzed. The median out-of-hospital CPR duration was 20 (range, 2-164) min, with only 35 (3.5 %) patients showing favorable neurological outcomes at 1 month. The proportion of favorable neurological outcomes decreased rapidly for up to 33 min of out-of-hospital CPR and then plateaued to 0.3 %; only three patients achieved favorable neurological outcomes after 33 min of CPR. An out-of-hospital CPR duration of >33 min was associated with poor neurological outcomes (sensitivity, 0.17 [95 % confidence interval: 0.15-0.20]; specificity, 0.91 [0.77-0.98]; and positive predictive value, 0.98 [0.95-1.00]). Prehospital EMS-initiated CPR duration for children with drowning-induced cardiac arrest was inversely associated with one-month favorable neurological outcomes. Favorable neurological outcomes after >33 min of out-of-hospital CPR were extremely rare, though accurately predicting the outcome remains challenging.

Komori A ，Iriyama H ，Abe T 《-》

Prehospital cardiopulmonary resuscitation duration and neurological outcome after out-of-hospital cardiac arrest among children by location of arrest: a Nationwide cohort study.

Shida H ，Matsuyama T ，Kiyohara K ，Kitamura T ，Kishimori T ，Kiguchi T ，Nishiyama C ，Kobayashi D ，Okabayashi S ，Shimamoto T ，Kawamura T ，Iwami T ... -  《Scandinavian Journal of Trauma Resuscitation & Emergency Medicine》

Duration of prehospital and in-hospital cardiopulmonary resuscitation and neurological outcome in paediatric out-of-hospital cardiac arrest.

Because of their young age and lack of known comorbidities, paediatric patients with out-of-hospital cardiac arrest (OHCA) often undergo prolonged cardiopulmonary resuscitation (CPR). We aimed to determine the association between prehospital and in-hospital CPR duration and neurological outcomes. We conducted a retrospective analysis of data from the Japanese Association for Acute Medicine-OHCA Registry for patients <18 years of age with OHCA between June 2014 and December 2019. All patients received prehospital CPR by emergency medical service (EMS). The aetiologies of arrest included traumatic and atraumatic causes. The primary outcome measure was a 1-month neurological outcome of moderate disability or better (Pediatric Cerebral Performance Category 1-3). We calculated the dynamic probability and cumulative proportion of 1-month moderate disability or better neurological outcomes. Dynamic probability calculates patient outcomes during CPR per min. We performed multivariate logistic regression analysis to explore the association between longer CPR duration (as an ordinal variable) and 1-month poorer neurological outcomes. Among 1007 eligible children, 252 achieved return of spontaneous circulation and 53 had a 1-month moderate disability or better neurological outcome. The dynamic probability of a 1-month moderate disability or better neurological outcome dropped below 0.01 at 64 min (0.005, 95% CI 0.001 to 0.017). The cumulative proportion of a 1-month moderate disability or better neurological outcome exceeded 0.99 at 68 min (1, 95% CI 1 to 1). With increasing CPR time from CPR initiation by EMS, both crude and adjusted ORs for 1-month neurological outcomes gradually decreased. Using a large Japanese database of paediatric OHCA patients, we found that longer CPR duration was associated with a lower likelihood of a 1-month moderate disability or better neurological outcome. Less than 1% of paediatric patients exhibited 1-month moderate disability or better neurological outcomes when total CPR duration is more than 64 min.

Yasuda M ，Amagasa S ，Kashiura M ，Yasuda H ，Uematsu S ... -  《-》

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 ... -  《-》

Duration of Prehospital Cardiopulmonary Resuscitation and Favorable Neurological Outcomes for Pediatric Out-of-Hospital Cardiac Arrests: A Nationwide, Population-Based Cohort Study.

The appropriate duration of cardiopulmonary resuscitation (CPR) for pediatric out-of-hospital cardiac arrests (OHCAs) remains unclear and may differ based on initial rhythm. We aimed to determine the relationship between the duration of prehospital CPR by emergency medical services (EMS) personnel and post-OHCA outcomes. We analyzed the records of 12 877 pediatric patients who experienced OHCAs (<18 years of age). Data were recorded in a nationwide Japanese database between 2005 and 2012. Study end points were 30-day survival and 30-day survival with favorable neurological outcomes (Cerebral Performance Category [CPC] scale 1-2). Prehospital EMS-initiated CPR duration was defined as the time from CPR initiation by EMS personnel to prehospital return of spontaneous circulation (ROSC) or to hospital arrival when prehospital ROSC was not achieved during prehospital CPR efforts. The rates of 30-day survival and 30-day CPC 1 to 2 were 9.1% (n=1167) and 2.5% (n=325), respectively. Prehospital EMS-initiated CPR duration was significantly and inversely associated with 30-day outcomes (adjusted odds ratio for 1-minute increments: 0.94, 95% confidence interval: 0.93-0.95 for survival; adjusted odds ratio: 0.90, 95% confidence interval: 0.88-0.92 for CPC 1-2). The duration of prehospital EMS-initiated CPR, beyond which the chance for favorable outcomes diminished to <1%, was 42 minutes for each key outcome, 30-day survival, and 30-day survival with CPC 1 to 2. When categorized by initial rhythm, the prehospital EMS-initiated CPR durations beyond which the chance for 30-day survival with CPC 1 to 2 diminished to <1% were 39 minutes for shockable rhythms, 42 minutes for pulseless electric activity, and 46 minutes for asystole, respectively. In patients with bystander-initiated CPR, the prehospital CPR duration, beyond which the chance for favorable outcome diminished to <1%, was 46 minutes from call receipt. Prehospital EMS-initiated CPR duration for pediatric OHCAs was independently and inversely associated with 30-day favorable outcomes. The duration of prehospital EMS-initiated CPR, beyond which the chance for 30-day favorable outcomes diminished to <1%, was 42 minutes. However, the CPR duration to achieve this proportion of outcomes differed based on initial rhythm. Further research is required to elucidate appropriate CPR duration for pediatric OHCAs, including in-hospital CPR time. URL: https://clinicaltrials.gov. Unique identifier: NCT02432196.

Goto Y ，Funada A ，Goto Y 《-》