Abstract
BackgroundA 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.MethodsWe 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.ResultsAmong 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.ConclusionsHerein, 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.
Highlights
A favorable neurological outcome is closely related to patient characteristics and total cardiopulmo‐ nary resuscitation (CPR) duration
Resuscitation-related variables, laboratory values, and treatments were compared between patients with favorable and unfavorable outcomes (Table 1)
No intergroup differences were observed in the emergency medical service (EMS) response time or transport time
Summary
A favorable neurological outcome is closely related to patient characteristics and total cardiopulmo‐ nary resuscitation (CPR) duration. The total CPR duration consists of pre-hospital and in-hospital durations. Consensus is lacking on the optimal total CPR duration. 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. Longer cardiopulmonary resuscitation (CPR) duration in cases of out-of-hospital cardiac arrest (OHCA) is associated with reduced favorable neurological outcomes. Consensus is lacking regarding the optimal CPR duration before termination. Park et al Scand J Trauma Resusc Emerg Med (2022) 30:5 the upper limit of CPR duration is essential for stopping futile resuscitation efforts. Even if appropriate advanced life support is implemented, identifying and correcting all the causes of OHCA in the field is challenging
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