Abstract 12843: Impact of Age on Optimal Cardiopulmonary Resuscitation Duration to Achieve Favorable Neurological Outcomes After Out-of-hospital Cardiac Arrest: Evidence From a Large-scale Registry in Japan

Abstract

Introduction: The optimal duration of cardiopulmonary resuscitation (CPR) for patients with out-of-hospital cardiac arrest (OHCA) before cessation of CPR is unclear and could differ according to age. Hypothesis: We determined the relationship between the duration of prehospital CPR performed by emergency medical service (EMS) personnel and survival with favorable neurological outcome (cerebral performance category scale, category 1 or 2; CPC 1-2) after OHCA by age. Methods: We analyzed the records of 17,238 OHCA patients (age ≥18 years) who achieved return of spontaneous circulation (ROSC) before arrival at the hospital. Data were obtained from a prospectively recorded Japanese national Utstein-style database for 2 years (2011-2012). The time from initiation of CPR by EMS personnel to prehospital ROSC (CPR duration) was calculated. The primary end point was 1-month CPC 1-2. Results: The rate of 1-month CPC 1-2 was 21.9% (3771 of 17238) for whole OHCA. The CPR duration was independently associated with a decreased rate of 1-month CPC 1-2 (adjusted odds ratio 0.94; 95% confidence interval 0.94-0.95). The CPR duration at which the probability of 1-month CPC 1-2 decreased to <1% was 24 min for whole OHCA. The minimum CPR duration to achieve a cumulative proportion >99% for 1-month CPC 1-2 was 35 min for whole OHCA. When sorted by age, the rates of 1-month CPC 1-2 were 36.3% (1822 of 5018), 25.0% (926 of 3697), 14.2% (688 of 4847), 9.7% (314 of 3243), and 4.8% (21 of 433), for 18-64, 65-74, 75-84, 85-94, and ≥95 years, respectively. The CPR duration at which the probability of 1-month CPC 1-2 decreased to <1% were 28, 24, 22, 21, and 19 min, for 18-64, 65-74, 75-84, 85-94, and ≥95 years, respectively. The minimum CPR duration to achieve a cumulative proportion >99% for 1-month CPC 1-2 were 34, 34, 35, 39, and 36 min for 18-64, 65-74, 75-84, 85-94, and ≥95 years, respectively. Conclusions: These results demonstrate that elderly OHCA patients had worse outcome. The more elderly the OHCA patients were, the earlier the probability of 1-month CPC 1-2 decreased to <1%; however, to achieve a cumulative proportion of >99% for 1-month CPC 1-2, a longer CPR duration was required. When considering cessation of CPR, the difference of optimal CPR duration by age should be taken into consideration.