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Observational Study
. 2017 Apr 21;17(1):59.
doi: 10.1186/s12871-017-0351-1.

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

Masahiro Kashiura  1 , Yuichi Hamabe  2 , Akiko Akashi  2 , Atsushi Sakurai  3 , Yoshio Tahara  4 , Naohiro Yonemoto  5 , Ken Nagao  6 , Arino Yaguchi  7 , Naoto Morimura  8 ; SOS-KANTO 2012 Study Group
Collaborators, Affiliations
Observational Study

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

Masahiro Kashiura et al. BMC Anesthesiol. .

Abstract

Background: The 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.

Methods: Data 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.

Results: Of 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%.

Conclusions: The 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.

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

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Figures

Fig. 1
Fig. 1
Flow diagram for patient selection
Fig. 2
Fig. 2
The dynamic probability of either a 1-month favorable neurologic outcome or 1-month survival relative to all patients against the duration of cardiopulmonary resuscitation. The short-dashed lines reflect the 95% confidence interval
Fig. 3
Fig. 3
Cumulative proportion of 1-month neurologically favorable outcomes and survival against the duration of cardiopulmonary resuscitation. The short-dashed lines reflect the 95% confidence interval
See this image and copyright information in PMC

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