Abstract
BackgroundOptimal acceptable time intervals from collapse to bystander cardiopulmonary resuscitation (CPR) for neurologically favorable outcome among adults with witnessed out-of-hospital cardiopulmonary arrest (CPA) have been unclear. Our aim was to assess the optimal acceptable thresholds of the time intervals of CPR for neurologically favorable outcome and survival using a recursive partitioning model.Methods and FindingsFrom January 1, 2005 through December 31, 2009, we conducted a prospective population-based observational study across Japan involving consecutive out-of-hospital CPA patients (N = 69,648) who received a witnessed bystander CPR. Of 69,648 patients, 34,605 were assigned to the derivation data set and 35,043 to the validation data set. Time factors associated with better outcomes: the better outcomes were survival and neurologically favorable outcome at one month, defined as category one (good cerebral performance) or two (moderate cerebral disability) of the cerebral performance categories. Based on the recursive partitioning model from the derivation dataset (n = 34,605) to predict the neurologically favorable outcome at one month, 5 min threshold was the acceptable time interval from collapse to CPR initiation; 11 min from collapse to ambulance arrival; 18 min from collapse to return of spontaneous circulation (ROSC); and 19 min from collapse to hospital arrival. Among the validation dataset (n = 35,043), 209/2,292 (9.1%) in all patients with the acceptable time intervals and 1,388/2,706 (52.1%) in the subgroup with the acceptable time intervals and pre-hospital ROSC showed neurologically favorable outcome.ConclusionsInitiation of CPR should be within 5 min for obtaining neurologically favorable outcome among adults with witnessed out-of-hospital CPA. Patients with the acceptable time intervals of bystander CPR and pre-hospital ROSC within 18 min could have 50% chance of neurologically favorable outcome.
Highlights
The critical lifesaving steps of Basic Life Support (BLS) include immediate recognition, activation of the emergency response system, and early cardiopulmonary resuscitation (CPR), immediate defibrillation for ventricular tachycardia/ventricular fibrillation (VT/VF) [1]
Initiation of CPR should be within 5 min for obtaining neurologically favorable outcome among adults with witnessed out-of-hospital cardiopulmonary arrest (CPA)
For achieving neurologically favorable outcome at one month, we found the following results: bystander CPR should be initiated within 5 min from the time of collapse; the ambulances should arrive at the scene within 11 min after the time of collapse; the ambulances should bring patients to hospitals within 19 min after the time of collapse
Summary
The critical lifesaving steps of Basic Life Support (BLS) include immediate recognition, activation of the emergency response system, and early cardiopulmonary resuscitation (CPR), immediate defibrillation for ventricular tachycardia/ventricular fibrillation (VT/VF) [1]. When an adult suddenly collapses, whoever is nearby and witnesses it should activate the emergency system and begin chest compressions regardless of his/her experience for CPR training. Some laypersons could not provide bystander CPR. One minute delay of CPR initiation may result in about 10% reduction of survival chance [2]. 10-minute delay of CPR initiation might indicate there are few chances for CPA patients to survive. Optimal acceptable time intervals from collapse to bystander cardiopulmonary resuscitation (CPR) for neurologically favorable outcome among adults with witnessed out-of-hospital cardiopulmonary arrest (CPA) have been unclear. Our aim was to assess the optimal acceptable thresholds of the time intervals of CPR for neurologically favorable outcome and survival using a recursive partitioning model
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