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Our data showed that out-of-hospital cardiac arrest (OHCA) patients with return of spontaneous circulation (ROSC) obtained in the field did not typically survive with favorable neurological outcomes, whereas more than half of OHCA cases who survived to hospital with favorable neurological recovery did not achieve ROSC at scene. However, it still remains unknown how long the duration of pre-hospital cardiopulmonary resuscitation should be prior to transporting the victims to hospital for further efforts or declaring termination of resuscitation attempts in the field by emergency medical service EMS providers. In this study, we investigated whether the pre-hospital resuscitation duration was associated with survival to hospital discharge as well as neurological outcomes of OHCA patients and tried to find the appropriate time duration for pre-hospital resuscitation attempts by EMS providers to improve outcomes of OHCA patients.
A secondary, retrospective and observational analysis was performed on all adult non-traumatic OHCA in ROC PRIMED study from June 2007 through November 2009 (Clinicaltrials.gov NCT00394706). Among a total of 17177 OHCA cases, 7445(43.3%) patients who were treated and transported to emergency department (ED) or hospital were enrolled. We described the demographics, pre-hospital characteristics and vital interventions in ED and hospital of all enrolled cases. Patients stratified by MRS at hospital discharge and whether ROSC achieved in the field or not, were also compared. Logistic regression was employed to explore the association of pre-hospital resuscitation duration and survival to hospital discharge and favorable neurologic recovery.
Of all 7445 treated and transported OHCA cases, 3337(44.8%) obtained ROSC in the field, 1150(15.4%) survived to hospital discharge, but only 868 patients (11.7%) achieved good functional recovery. Pre-hospital resuscitation duration in patients with and without ROSC at scene was (15.3+/-9.46) and (27.3+/-11.27) minutes, while survivors with and without good function recovery and death to hospital discharge was (10.3+/-8.87) and (12.4+/-9.15) and (22.4+/-1.50) minutes respectively. Further analysis revealed that with the pre-hospital resuscitation duration prolonged, more patients obtained ROSC while the proportion of patients achieving a favorable neurologic outcome was declined. The unadjusted odds ratio (OR) of pre-hospital resuscitation duration for favorable neurological outcomes at hospital discharge was 0.880(95%CI 0.871-0.888, p=0.000). When adjusted with pre-hospital covariates, OR was 0.895(95%CI 0.881-0.909, p=0.000). After adjusting for both pre-hospital and inpatient covariates, OR was 0.927(95%CI 0.908-0.945, p=0.000). In adjusted model, the pre-hospital resuscitation duration independently contributed to survival to hospital discharge (OR0.923; 95%CI 0.908-0.945; p=0.000).
Shorter pre-hospital resuscitation duration is independently associated with improved outcomes in out-of-hospital cardiac arrest.