Clinical paperThe association of duration of resuscitation and long-term survival and functional outcomes after out-of-hospital cardiac arrest
Introduction
Out-of-hospital cardiac arrest (OHCA) affects more than 356,000 people annually in the United States.1 The overall community rates of survival to hospital discharge remain poor between 3–16 %.2, 3 The importance of understanding factors impacting long-term outcomes has been emphasized in American Heart Association 2020 CPR Resuscitation guidelines with the sixth Chain of Survival link focusing on recovery post-cardiac arrest. Long-term survival is less well documented, with reports of 1- and 3-year survival post-discharge ranging 68–92 % and 80 % respectively.4, 5, 6, 7
Previous data has shown that longer emergency medical system performed cardiopulmonary resuscitation-to-return of spontaneous circulation (EMS CPR-to-ROSC) intervals are linearly associated with poorer hospital-discharge survival and neurologic outcomes.8, 9 However, the impact of this interval on long-term outcomes post-discharge is unclear. We hypothesized that long-term survival would be worse among those with longer durations of EMS-performed resuscitation. It is unclear if certain patient characteristics are more refractory to resuscitative efforts as pre-OHCA comorbidities and medications have been reported with worse survival outcomes at time of hospital discharge.10, 11
We examined the relationship between the EMS CPR-to-ROSC interval and outcomes at hospital discharge, and 1- and 3-years post-discharge. Our secondary objective evaluated patient pre-OHCA comorbidities and medications associated with longer periods of professional resuscitation.
Section snippets
Study setting, data sources, and linkages
British Columbia (BC) Cardiac Arrest Registry is a provincial registry of prospectively identified non-traumatic EMS-assessed OHCAs. Cases were included from four metropolitan regions in BC: Victoria/Nanaimo, Vancouver/North Shore, Fraser Valley, and Kelowna/Kamloops region. Registry staff prospectively collected data on patient and cardiac arrest characteristics, bystander interventions, and prehospital professionally-delivered diagnostics and treatments via clinical charting, data from 911
Characteristics of OHCA population
There were 10,674 cases of EMS-treated, non-traumatic adult OHCA between January 2009 - December 2016 in BC. We excluded 433 cases due to subsequent cardiac arrest after index cardiac arrest (n = 48), missing ROSC time (n = 302) or incomplete follow-up data (n = 83), leaving a total of 10,241 for analysis (Fig. 1).
Cardiac arrest patient baseline characteristics (n = 10,241) are outlined in Table 1. The median age was 69 (IQR 56.1–80.9) years and 3,282 (32.0 %) were women; 7,769 (75.9 %) had
Discussion
We examined 10,674 EMS-treated adult non-traumatic OHCAs, with detailed data on pre-OHCA comorbidities, prehospital and in-hospital characteristics and interventions, and post-discharge long-term survival and functional status. We found that the longer EMS CPR-to-ROSC interval was associated with poor survival and functional outcomes at hospital discharge, consistent with previous studies. Contrary to our study hypothesis, longer EMS CPR-to-ROSC interval was not associated with worse 1- or
Conclusion
This study demonstrated that longer EMS CPR-to-ROSC interval was non-linearly associated with increased poorer survival at hospital discharge, but not associated with survival at 1- and 3 years. Similarly, longer EMS CPR-to-ROSC was associated with poor functional outcomes at hospital discharge, but not at 1-year post-discharge among those who survived to hospital discharge. In patients achieving ROSC, pre-arrest co-morbidities including diabetes, chronic kidney disease (CKD), and prior MI
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
CRediT authorship contribution statement
Jocelyn Chai: Methodology, Writing – original draft. Christopher B. Fordyce: Supervision, Conceptualization, Writing – review & editing. Meijiao Guan: Writing – review & editing. Karin Humphries: Writing – review & editing. Jacob Hutton: Writing – review & editing. Jim Christenson: Writing – review & editing. Brian Grunau: Supervision, Conceptualization, Methodology, Writing – review & editing.
Acknowledgements
None.
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