Clinical paper The association of duration of resuscitation and long-term survival and functional outcomes after out-of-hospital cardiac arrest

被引:23
作者
Chai, Jocelyn [1 ,6 ]
Fordyce, Christopher B. [1 ,2 ,3 ]
Guan, Meijiao [2 ]
Humphries, Karin [2 ,3 ]
Hutton, Jacob [1 ,4 ]
Christenson, Jim [1 ,5 ]
Grunau, Brian [1 ,2 ,4 ,5 ]
机构
[1] Univ British Columbia, Fac Med, Vancouver, BC, Canada
[2] Univ British Columbia, Ctr Hlth Evaluat & Outcome Sci, Vancouver, BC, Canada
[3] Univ British Columbia, Div Cardiol, Vancouver, BC, Canada
[4] British Columbia Emergency Hlth Serv, Vancouver, BC, Canada
[5] Univ British Columbia, Dept Emergency Med, Vancouver, BC, Canada
[6] Univ British Columbia, Dept Internal Med, 899 West 12th Ave, Vancouver, BC V5Z1M9, Canada
关键词
Cardiac arrest; Return of spontaneous circulation; Cardiopulmonary resuscitation; MYOCARDIAL-INFARCTION; PROGNOSIS;
D O I
10.1016/j.resuscitation.2022.11.020
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Aim: Longer emergency medical system cardiopulmonary-resuscitation-to-return of-spontaneous-circulation (EMS CPR-to-ROSC) interval has been associated with worse hospital discharge outcomes after out-of-hospital cardiac arrest (OHCA). We hypothesized that this association extends post-discharge in hospital survivors. We investigated whether pre-arrest co-morbidities influence the duration of resuscitation.Methods: We included EMS-treated adult OHCA (January 2009 - December 2016) from British Columbia Cardiac Arrest Registry linked to provincial databases. Pre-OHCA characteristics were compared by < 10, 10-20, and > 20 min interval categories. Outcomes included survival and functional outcomes at hospital discharge and 1- and 3-year survival. We examined the relationship between CPR-to-ROSC intervals and survival using Kaplan-Meier. We examined the relationship between the CPR-to-ROSC interval (continuous variable) with all outcomes using regression models.Results: Among 10,241 OHCA, 4604 (45%) achieved ROSC, with a median CPR-to-ROSC interval of 15.5 (IQR 9.0-22.9) minutes. Diabetes, chronic kidney disease, and prior myocardial infarction were associated with longer CPR-to-ROSC intervals. 1245 (12.2%) survived to hospital discharge. Among hospital survivors, Kaplan-Meier survival at 1- and 3-years were 92% [95% CI 90-93%] and 84% [95% CI 82-86%] respectively; survival curves stratified by CPR-to-ROSC intervals were not statistically different. Longer CPR-to-ROSC interval was non-linearly associated with lower survival and functional outcomes at hospital discharge but not with post-discharge outcomes.Conclusion: Longer CPR-to-ROSC interval was associated with lower survival at hospital discharge and was influenced by pre-arrest comorbidities. However, these intervals were not associated with long-term survival or functional outcome among hospital survivors, suggesting early risk of longer CPR-to-ROSC intervals does not persist.
引用
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页数:12
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