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How long is long enough? Good neurologic outcome in out-of-hospital cardiac arrest survivors despite prolonged resuscitation: a retrospective cohort study

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Abstract

Background

Despite all efforts, mortality of out of hospital cardiac arrest (OHCA) remains high. Patients with OHCA due to a primary shockable rhythm typically have a better prognosis. However, outcome worsens if return of spontaneous circulation (ROSC) cannot be achieved quickly. There is insufficient evidence for maximum duration of resuscitation in these patients and it is unclear, which patients profit from transport under ongoing CPR.

Objective

Investigate predictors for favourable neurologic outcome in OHCA patients with presumed cardiac cause due to refractory shockable rhythm (rSR).

Methods

Retrospective analysis of OHCA patients that presented to a tertiary hospital due to a rSR.

Results

One hundred seventy-five OHCA patients with presumed cardiac cause due to rSR were included. Overall hospital mortality was 50% and 83% of initial survivors were discharged with a good neurologic outcome [cerebral performance category (CPC) 1–2]. In patients with a time from cardiac arrest to ROSC of > 45 min, 18% survived to CPC 1–2. Independent predictors for good neurologic outcome were age, lower no-flow time and lower serum lactate levels at hospital arrival.

Conclusion

In an urban setting, a significant proportion of OHCA patients with rSR can survive to a good neurologic outcome, despite very long time to ROSC.

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Acknowledgements

The study was not sponsored. The graphical abstract was created using images from Servier Medical Art Commons Attribution 3.0 Unported License (https://smart.servier.com).

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Authors and Affiliations

  1. Division of Cardiology, Pneumology, Angiology and Intensive Care, Department of Internal Medicine III, University of Cologne, 50924, Cologne, Germany

    Simon Braumann, Felix Sebastian Nettersheim, Christopher Hohmann, Tobias Tichelbäcker, Joana Adler, Richard Julius Nies, Dennis Mehrkens, Samuel Lee, Hannes Reuter, Stephan Baldus & Christoph Adler

  2. Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    Martin Hellmich

  3. Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany

    Anton Sabashnikov & Ilija Djordjevic

  4. Department of Emergency Medicine, Fire Department City of Cologne, Cologne, Germany

    Robert Stangl & Christoph Adler

  5. Department of Internal Medicine and Cardiology, Ev. Klinikum Köln-Weyertal, Cologne, Germany

    Hannes Reuter

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  1. Simon Braumann
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  2. Felix Sebastian Nettersheim
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Correspondence to Christoph Adler.

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Braumann, S., Nettersheim, F.S., Hohmann, C. et al. How long is long enough? Good neurologic outcome in out-of-hospital cardiac arrest survivors despite prolonged resuscitation: a retrospective cohort study. Clin Res Cardiol 109, 1402–1410 (2020). https://doi.org/10.1007/s00392-020-01640-x

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  • DOI: https://doi.org/10.1007/s00392-020-01640-x

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