Abstract 12440: Impact of Changes in the Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care on Neurologically Intact Survival

Abstract

Introduction: The AHA and International Liaison Committee on Resuscitation (ILCOR) published the Guidelines 2000 for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC). Since 2000, the ILCOR has reported the International Consensus on CPR and ECC Science with Treatment Recommendations (CoSTR) in 5-year cycles. However, few nationwide studies have investigated the efficacy of changes in the CPR guidelines. Methods: A total of 1,136,283 adult patients who received CPR after out-of-hospital cardiac arrest (OHCA) between 2005 and 2014 were included from the All-Japan Utstein Registry, a prospective, nationwide, population-based registry. We divided the study patients into 3 groups according to each guideline era (the G2000 era was cases in 2005, the CoSTR2005 era from 2006 to 2010 and the CoSTR2010 era from 2011 to 2014). The primary endpoint was favorable 30-day neurological outcome after OHCA. Multiple logistic regression analysis for primary endpoint was performed to adjust for possible confounders due to imbalances in baseline characteristics. Results: Of the 1,136,283 patients, 100,509 (8.8%) were in the G2000 era, 549,147 (48.3%) in the CoSTR2005 era and 486,627 (42.8%) in the CoSTR2010 era. Baseline characteristics exhibited significant differences among the three groups, including age, sex, time interval from call receipt to paramedic arrival at patient’s side, arrest witnessed, bystander CPR, initial arrest rhythm, advanced CPR, cause of OHCA, etc. After adjustment for resuscitation, the CoSTR2005 and the CoSTR2010 (reference, the G2000) were independent predictor of favorable 30-day neurological outcome (the CoSTR2005: adjusted OR, 1.588; 95% CI: 1.488-1.696, and the CoSTR2010: adjusted OR, 2.100; 95% CI: 1.966-2.242, respectively) and the subgroups of patients with even unwitnessed OHCA (the CoSTR2005: adjusted OR, 1.210; 95% CI: 1.057-1.386, and the CoSTR2010: adjusted OR, 1.484; 95% CI: 1.296-1.700, respectively). Conclusions: In a nationwide study for all adult patients with OHCA, the CoSTR2005 had favorable neurological outcome 1.6 times as high as the G2000, and also the CoSTR2010 had it 2.2 times. The neurologically intact survival increased each time the CPR guidelines were changed.