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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2017

Open Access 01-12-2017 | Research article

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

Authors: Masahiro Kashiura, Yuichi Hamabe, Akiko Akashi, Atsushi Sakurai, Yoshio Tahara, Naohiro Yonemoto, Ken Nagao, Arino Yaguchi, Naoto Morimura, on behalf of the SOS-KANTO 2012 Study Group

Published in: BMC Anesthesiology | Issue 1/2017

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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.
Literature
1.
Berdowski J, Berg RA, Tijssen JGP, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010;81:1479–87.CrossRefPubMed
2.
Sasson C, Rogers MAM, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63–81.CrossRefPubMed
3.
Shih CL, Lu TC, Jerng JS, Lin CC, Liu YP, Chen WJ, et al. A web-based Utstein style registry system of in-hospital cardiopulmonary resuscitation in Taiwan. Resuscitation. 2007;72:394–403.CrossRefPubMed
4.
Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008;372:554–61.CrossRefPubMed
5.
Goto Y, Funada A, Goto Y. Relationship between the duration of cardiopulmonary resuscitation and favorable neurological outcomes after out-of-hospital cardiac arrest: a prospective, nationwide, population-based cohort study. J Am Heart Assoc. 2016;4:e002819.CrossRef
6.
Grunau B, Reynolds JC, Scheuermeyer FX, Stenstrom R, Pennington S, Cheung C, et al. Comparing the prognosis of those with initial shockable and non-shockable rhythms with increasing durations of CPR: Informing minimum durations of resuscitation. Resuscitation. 2016;101:50–6.CrossRefPubMed
7.
Morrison LJ, Kierzek G, Diekema DS, Sayre MR, Silvers SM, Idris AH, et al. Part 3: ethics: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S665–75.CrossRefPubMed
8.
Mancini ME, Diekema DS, Hoadley TA, Kadlec KD, Leveille MH, McGowan JE, et al. Part 3: Ethical Issues: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S383–96.CrossRefPubMed
9.
Kashiura M, SOS-KANTO 2012 Study Group. Is it possible to terminate resuscitation in accordance with the termination of resuscitation rule? J Thorac Dis. 2016;8:E1435–7.CrossRefPubMedPubMedCentral
10.
Atkins DL. Doing the same thing over and over, yet expecting different results. Circulation. 2013;128:2465–7.CrossRefPubMed
11.
Nehme Z, Andrew E, Bernard S, Smith K. Impact of cardiopulmonary resuscitation duration on survival from paramedic witnessed out-of-hospital cardiac arrests: An observational study. Resuscitation. 2016;100:25–31.CrossRefPubMed
12.
Arima T, Nagata O, Sakaida K, Miura T, Kakuchi H, Ikeda K, et al. Relationship between duration of prehospital resuscitation and favorable prognosis in ventricular fibrillation. Am J Emerg Med. 2015;33:677–81.CrossRefPubMed
13.
SOS-KANTO 2012 study group. Changes in pre- and in-hospital management and outcomes for out-of-hospital cardiac arrest between 2002 and 2012 in Kanto, Japan: the SOS-KANTO 2012 Study. Acute Med Surg. 2015;2:225–33.
14.
Kitamura N, Nakada T-A, Shinozaki K, Tahara Y, Sakurai A, Yonemoto N, et al. Subsequent shock deliveries are associated with increased favorable neurological outcomes in cardiac arrest patients who had initially non-shockable rhythms. Crit Care. 2015;19:322.CrossRefPubMedPubMedCentral
15.
Kashiura M, Hamabe Y, Akashi A, Sakurai A, Tahara Y, Yonemoto N, et al. Applying the termination of resuscitation rules to out-of-hospital cardiac arrests of both cardiac and non-cardiac etiologies: a prospective cohort study. Crit Care. 2016;20:49.CrossRefPubMedPubMedCentral
16.
Kajino K, Kitamura T, Iwami T, Ong MEH, Hiraide A, Shimazu T, et al. Current termination of resuscitation (TOR) guidelines predict neurologically favorable outcome in Japan. Resuscitation. 2013;84:54–9.CrossRefPubMed
17.
Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A, et al. Nationwide public-access defibrillation in Japan. N Engl J Med. 2010;362:994–1004.CrossRefPubMed
18.
Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 2015;96:328–40.CrossRefPubMed
19.
Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation. 1991;84:960–75.CrossRefPubMed
20.
Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, et al. Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132:S465–82.CrossRefPubMedPubMedCentral
21.
Sandroni C, Cariou A, Cavallaro F, Cronberg T, Friberg H, Hoedemaekers C, et al. Prognostication in comatose survivors of cardiac arrest: An advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Resuscitation. 2014;85:1779–89.CrossRefPubMed
22.
Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation. 2015;95:302–11.CrossRefPubMed
23.
Abramson NS, Safar P, Detre KM, Kelsey SF, Monroe J, Reinmuth O, et al. Neurologic recovery after cardiac arrest: effect of duration of ischemia. Brain Resuscitation Clinical Trial I Study Group. Crit Care Med. 1985;13:930–1.CrossRefPubMed
24.
Takasu A, Sakamoto T, Okada Y. Arterial base excess after CPR: the relationship to CPR duration and the characteristics related to outcome. Resuscitation. 2007;73:394–9.CrossRefPubMed
25.
Menegazzi JJ, Ramos R, Wang HE, Callaway CW. Post-resuscitation hemodynamics and relationship to the duration of ventricular fibrillation. Resuscitation. 2008;78:355–8.CrossRefPubMedPubMedCentral
26.
Komatsu T, Kinoshita K, Sakurai A, Moriya T, Yamaguchi J, Sugita A, et al. Shorter time until return of spontaneous circulation is the only independent factor for a good neurological outcome in patients with postcardiac arrest syndrome. Emerg Med J. 2013;31:549–55.CrossRefPubMedPubMedCentral
27.
Reynolds JC, Frisch A, Rittenberger JC, Callaway CW. Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation. 2013;128:2488–94.CrossRefPubMedPubMedCentral
28.
Cha WC, Lee EJ, Hwang S-S. The duration of cardiopulmonary resuscitation in emergency departments after out-of-hospital cardiac arrest is associated with the outcome: A nationwide observational study. Resuscitation. 2015;96:323–7.CrossRefPubMed
29.
Mosca MS, Narotsky DL, Mochari-Greenberger H, Liao M, Mongero L, Beck J, et al. Duration of conventional cardiopulmonary resuscitation prior to extracorporeal cardiopulmonary resuscitation and survival among adult cardiac arrest patients. Perfusion. 2016;31:200–6.CrossRefPubMed
30.
Kim SJ, Jung JS, Park JH, Park JS, Hong YS, Lee SW. An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched study. Crit Care. 2014;18:535.CrossRefPubMedPubMedCentral
Metadata
Title
Association between cardiopulmonary resuscitation duration and one-month neurological outcomes for out-of-hospital cardiac arrest: a prospective cohort study
Authors
Masahiro Kashiura
Yuichi Hamabe
Akiko Akashi
Atsushi Sakurai
Yoshio Tahara
Naohiro Yonemoto
Ken Nagao
Arino Yaguchi
Naoto Morimura
on behalf of the SOS-KANTO 2012 Study Group
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2017
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-017-0351-1

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