Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest
Abstract Background A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. There...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13049-022-00993-8 |
| _version_ | 1819008441455214592 |
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| author | SungJoon Park Sung Woo Lee Kap Su Han Eui Jung Lee Dong-Hyun Jang Si Jin Lee Ji Sung Lee Su Jin Kim for the Korean Cardiac Arrest Research Consortium (KoCARC) Investigators |
| author_facet | SungJoon Park Sung Woo Lee Kap Su Han Eui Jung Lee Dong-Hyun Jang Si Jin Lee Ji Sung Lee Su Jin Kim for the Korean Cardiac Arrest Research Consortium (KoCARC) Investigators |
| author_sort | SungJoon Park |
| collection | DOAJ |
| description | Abstract Background A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR. Methods We conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service–assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge. Results Among 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55–62 and 24–34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43–53 and 45–71 min, respectively. Conclusions Herein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient’s resuscitation-related factors, despite prolonged CPR duration. |
| first_indexed | 2024-12-21T00:40:31Z |
| format | Article |
| id | doaj.art-f253589eaf5143c7930fc59433620cf6 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-12-21T00:40:31Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-f253589eaf5143c7930fc59433620cf62022-12-21T19:21:41ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412022-01-0130111110.1186/s13049-022-00993-8Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrestSungJoon Park0Sung Woo Lee1Kap Su Han2Eui Jung Lee3Dong-Hyun Jang4Si Jin Lee5Ji Sung Lee6Su Jin Kim7for the Korean Cardiac Arrest Research Consortium (KoCARC) InvestigatorsDepartment of Emergency Medicine, College of Medicine, Korea UniversityDepartment of Emergency Medicine, College of Medicine, Korea UniversityDepartment of Emergency Medicine, College of Medicine, Korea UniversityDepartment of Emergency Medicine, College of Medicine, Korea UniversityDepartment of Emergency Medicine, College of Medicine, Korea UniversityDepartment of Emergency Medicine, College of Medicine, Korea UniversityClinical Research Center, Asan Medical CenterDepartment of Emergency Medicine, College of Medicine, Korea UniversityAbstract Background A favorable neurological outcome is closely related to patient characteristics and total cardiopulmonary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. To date, consensus is lacking on the optimal total CPR duration. Therefore, this study aimed to determine the upper limit of total CPR duration, the optimal cut-off time at the pre-hospital level, and the time to switch from conventional CPR to alternative CPR such as extracorporeal CPR. Methods We conducted a retrospective observational study using prospective, multi-center registry of out-of-hospital cardiac arrest (OHCA) patients between October 2015 and June 2019. Emergency medical service–assessed adult patients (aged ≥ 18 years) with non-traumatic OHCA were included. The primary endpoint was a favorable neurological outcome at hospital discharge. Results Among 7914 patients with OHCA, 577 had favorable neurological outcomes. The optimal cut-off for pre-hospital CPR duration in patients with OHCA was 12 min regardless of the initial rhythm. The optimal cut-offs for total CPR duration that transitioned from conventional CPR to an alternative CPR method were 25 and 21 min in patients with initial shockable and non-shockable rhythms, respectively. In the two groups, the upper limits of total CPR duration for achieving a probability of favorable neurological outcomes < 1% were 55–62 and 24–34 min, respectively, while those for a cumulative proportion of favorable neurological outcome > 99% were 43–53 and 45–71 min, respectively. Conclusions Herein, we identified the optimal cut-off time for transitioning from pre-hospital to in-hospital settings and from conventional CPR to alternative resuscitation. Although there is an upper limit of CPR duration, favorable neurological outcomes can be expected according to each patient’s resuscitation-related factors, despite prolonged CPR duration.https://doi.org/10.1186/s13049-022-00993-8Cardiac arrestCardiopulmonary resuscitationNeurological outcomeOut-of-hospital cardiac arrestResuscitation |
| spellingShingle | SungJoon Park Sung Woo Lee Kap Su Han Eui Jung Lee Dong-Hyun Jang Si Jin Lee Ji Sung Lee Su Jin Kim for the Korean Cardiac Arrest Research Consortium (KoCARC) Investigators Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Cardiac arrest Cardiopulmonary resuscitation Neurological outcome Out-of-hospital cardiac arrest Resuscitation |
| title | Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest |
| title_full | Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest |
| title_fullStr | Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest |
| title_full_unstemmed | Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest |
| title_short | Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest |
| title_sort | optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out of hospital cardiac arrest |
| topic | Cardiac arrest Cardiopulmonary resuscitation Neurological outcome Out-of-hospital cardiac arrest Resuscitation |
| url | https://doi.org/10.1186/s13049-022-00993-8 |
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