Abstract
Background: Many patients with witnessed out-of-hospital cardiac arrest (OHCA) will not have CPR attempted until emergency medical services (EMS) personnel arrive. The potential for favourable outcomes in patients with increasing no-flow durations is unclear. While some extra-corporeal CPR programs have excluded patients without bystander CPR, others have treated these patients provided short durations to EMS arrival. We sought to describe the outcomes of patients with increasing no-flow durations to determine the potential viability of these patients. Methods: This study examined consecutive non-traumatic OHCA’s collected by a prospective registry in British Columbia (2007 and 2011). We included adult patients with bystander-witnessed OHCA but no attempt at bystander chest compressions. The primary variable of interest was the duration from the bystander 9-1-1 call to the time of CPR commencement by EMS. The primary endpoint was survival at hospital discharge. Multivariable logistic regression, with adjustment for sex, age, public location of arrest, and initial shockable rhythm, was used to assess the association of time to CPR and survival to hospital discharge. Results: Of 6571 EMS-treated OHCA’s, 1062 were included. The median age was 73 (IQR 58-82), 69% were male, and 35% had initial shockable rhythms. Overall survival was 13%. The median time to CPR commencement was 8.5 minutes (IQR 6.9 - 10.5). Time to CPR was independently associated with survival to hospital discharge (adjusted OR 0.85 per minute increase; 95% CI 0.78-0.92). Among survivors, the 90th percentile of time from 9-1-1 call to CPR was 10.3 minutes. Conclusion: In adult OHCA patients, no-flow durations were negatively correlated with outcome, however survival was observed with prolonged durations without CPR extending to 16 minutes. Patients with witnessed OHCA and no bystander CPR include survivors and aggressive resuscitation strategies are warranted.
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