Elsevier

Resuscitation

Volume 182, January 2023, 109654
Resuscitation

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

https://doi.org/10.1016/j.resuscitation.2022.11.020Get rights and content

Abstract

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 co-morbidities. 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.

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.

References (27)

  • G. Hirlekar et al.

    Comorbidity and survival in out-of-hospital cardiac arrest

    Resuscitation

    (2018)
  • Aparicio HJ, Benjamin EJ, Callaway CW, et al. Heart Disease and Stroke Statistics-2021 Update A Report from the...
  • Nichol G, Thomas E, Callaway CW, et al. Regional Variation in Out-of-Hospital Cardiac Arrest Incidence and Outcome....
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