TY - JOUR
T1 - Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest
AU - Rajan, Shahzleen
AU - Folke, Fredrik
AU - Kragholm, Kristian
AU - Hansen, Carolina Malta
AU - Granger, Christopher B.
AU - Hansen, Steen Møller
AU - Peterson, Eric D.
AU - Lippert, Freddy K.
AU - Søndergaard, Kathrine B.
AU - Køber, Lars
AU - Gislason, Gunnar H.
AU - Torp-Pedersen, Christian
AU - Wissenberg, Mads
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd
PY - 2016
Y1 - 2016
N2 - Aim It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return of spontaneous circulation (ROSC). Methods We included 1316 adult OHCA individuals with pre-hospital ROSC (2005–2011) handled by the largest nationwide ambulance provider in Denmark. Patients were stratified into 0–5, 6–10, 11–15, 16–20, 21–25 and >25 min of cardiopulmonary resuscitation (CPR) by emergency medical services until ROSC was achieved. Nursing home admission and diagnosis of anoxic brain damage were measured as proxies of poor neurological/functional outcomes. Findings Median time from CPR initiation to ROSC was 12 min (IQR: 7–18) while 20.4% achieved ROSC after >25 min. Overall, 37.5% (494) of the study population achieved 30-day survival. Thirty-day survival was inversely related to minutes of CPR to ROSC: ranging from 59.6% (127/213) for ≤5 min to 13.8% (19/138) for >25 min. If bystander initiated CPR before ambulance arrival, corresponding values ranged from 70.4% (107/152) to 21.8% (12/55). Of 30-day survivors, patients discharged to own home rather than nursing home ranged from 95.0% (124/127) to 84.7% (18/19), respectively. Of 30-day survivors, patients discharged without diagnosis of anoxic brain damage ranged from 98.4% (125/127) to 73.7% (14/19) for corresponding intervals. Conclusion Even those requiring prolonged resuscitation duration prior to ROSC had meaningful survival rates with the majority of survivors able to return to live in own homes. These data suggest that prolonged resuscitation is not futile.
AB - Aim It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return of spontaneous circulation (ROSC). Methods We included 1316 adult OHCA individuals with pre-hospital ROSC (2005–2011) handled by the largest nationwide ambulance provider in Denmark. Patients were stratified into 0–5, 6–10, 11–15, 16–20, 21–25 and >25 min of cardiopulmonary resuscitation (CPR) by emergency medical services until ROSC was achieved. Nursing home admission and diagnosis of anoxic brain damage were measured as proxies of poor neurological/functional outcomes. Findings Median time from CPR initiation to ROSC was 12 min (IQR: 7–18) while 20.4% achieved ROSC after >25 min. Overall, 37.5% (494) of the study population achieved 30-day survival. Thirty-day survival was inversely related to minutes of CPR to ROSC: ranging from 59.6% (127/213) for ≤5 min to 13.8% (19/138) for >25 min. If bystander initiated CPR before ambulance arrival, corresponding values ranged from 70.4% (107/152) to 21.8% (12/55). Of 30-day survivors, patients discharged to own home rather than nursing home ranged from 95.0% (124/127) to 84.7% (18/19), respectively. Of 30-day survivors, patients discharged without diagnosis of anoxic brain damage ranged from 98.4% (125/127) to 73.7% (14/19) for corresponding intervals. Conclusion Even those requiring prolonged resuscitation duration prior to ROSC had meaningful survival rates with the majority of survivors able to return to live in own homes. These data suggest that prolonged resuscitation is not futile.
KW - Cardiopulmonary resuscitation
KW - Epidemiology
KW - Prolonged resuscitation
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=84979524717&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84979524717&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2016.05.004
DO - 10.1016/j.resuscitation.2016.05.004
M3 - Article
C2 - 27224447
AN - SCOPUS:84979524717
SN - 0300-9572
VL - 105
SP - 45
EP - 51
JO - Resuscitation
JF - Resuscitation
ER -