Impact of time-to-compression on out-of-hospital cardiac arrest survival outcomes: A national registry study.

Autor: Goh JL; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: jialing.goh@mohh.com.sg., Pek PP; Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore., Fook-Chong SMC; Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore., Ho AFW; Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore., Siddiqui FJ; Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore., Leong BS; Emergency Medicine Department, National University Hospital, Singapore., Mao DRH; Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore., Ng W; Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore., Tiah L; Accident & Emergency, Changi General Hospital, Singapore., Chia MY; Emergency Department, Tan Tock Seng Hospital, Singapore., Tham LP; Children's Emergency, KK Women's and Children's Hospital, Singapore., Shahidah N; Department of Emergency Medicine, Singapore General Hospital, Singapore., Arulanandam S; Medical Department, Singapore Civil Defence Force, Singapore., Ong MEH; Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2023 Sep; Vol. 190, pp. 109917. Date of Electronic Publication: 2023 Jul 26.
DOI: 10.1016/j.resuscitation.2023.109917
Abstrakt: Objective: We aimed to quantify the association of no-flow interval in out-of-hospital cardiac arrests (OHCA) with the odds of neurologically favorable survival and survival to hospital discharge/ 30th day. Our secondary aim was to explore futility thresholds to guide clinical decisions, such as prehospital termination of resuscitation.
Methods: All OHCAs from 2012 to 2017 in Singapore were extracted. We examined the association between no-flow interval (continuous variable) and survival outcomes using univariate and multivariable logistic regressions. The primary outcome was survival with favorable cerebral performance (Glasgow-Pittsburgh Cerebral Performance Categories 1/2), the secondary outcome was survival to hospital discharge/ 30th day if not discharged. To determine futility thresholds, we plotted the adjusted probability of good neurological outcomes to no-flow interval.
Results: 12,771 OHCAs were analyzed. The per-minute adjusted OR when no-flow interval was incorporated as a continuous variable in the multivariable model was: good neurological function- aOR 0.98 (95%CI: 0.97-0.98); survival to discharge- aOR 0.98 (95%CI: 0.98-0.99). Taking the 1% futility of survival line gave a no-flow interval cutoff of 12 mins (NPV 99%, sensitivity 85% and specificity 42%) overall and 7.5 mins for witnessed arrests.
Conclusion: We demonstrated that prolonged no-flow interval had a significant effect on lower odds of favorable neurological outcomes, with medical futility occurring when no-flow interval was >12 mins (>7.5 mins for witnessed arrest). Our study adds to the literature of the importance of early CPR and EMS response and provided a threshold beyond traditional 'down-times', which could aid clinical decisions in TOR or OHCA management.
Competing Interests: 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.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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