Out-of-hospital cardiac arrest without return of spontaneous circulation in the field: Who are the survivors?

  • Author Footnotes
    1 Contributed to this paper equally.
    Yan Xiong
    Correspondence
    Corresponding author at: 58 Zhongshan 2nd Road, Guangzhou 510080, China.
    Footnotes
    1 Contributed to this paper equally.
    Affiliations
    Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China

    Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA
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  • Author Footnotes
    1 Contributed to this paper equally.
    Hong Zhan
    Footnotes
    1 Contributed to this paper equally.
    Affiliations
    Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
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  • Yuanzheng Lu
    Affiliations
    Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China

    Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA
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  • Author Footnotes
    1 Contributed to this paper equally.
    Kaipan Guan
    Footnotes
    1 Contributed to this paper equally.
    Affiliations
    Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
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  • Ngozi Okoro
    Affiliations
    Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA
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  • Denise Mitchell
    Affiliations
    Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA
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  • Megan Dwyer
    Affiliations
    Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA
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  • Auna Leatham
    Affiliations
    Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA
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  • Gilberto Salazar
    Affiliations
    Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA
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  • Xiaoxing Liao
    Affiliations
    Department of Emergency Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
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  • Ahamed Idris
    Correspondence
    Corresponding author at: 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA.
    Affiliations
    Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA
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  • Author Footnotes
    1 Contributed to this paper equally.

      Abstract

      Background

      Return of spontaneous circulation (ROSC) in the field is a vital determinant contributing to survival from out-of-hospital cardiac arrest (OHCA). However, nearly one third of survivors at the Dallas-Fort Worth (DFW) Resuscitation Outcomes Consortium (ROC) site did not obtain ROSC in the field.

      Methods

      A retrospective, observational analysis was performed on all adult patients with non-traumatic OHCA treated on scene and transported to hospital, who did not gain ROSC in the field at DFW ROC site between 2006 through 2011.We described the demographics, pre-hospital characteristics and outcomes of all enrolled cases. Those patients without ROSC in the field, who did and did not meet Termination of Resuscitation (TOR) criteria in the field, were also compared.

      Results

      Among a total of 5099 treated and transported non-traumatic OHCA cases, 83.2% (4243) were included in this study as patients without ROSC gained in the field, of which 66.6% (2827) met TOR criteria but still were treated and transported; 1.9% (79) survived to hospital discharge. Further analysis showed that 39.2% (31) of survivors met TOR rule, accounting for 1.1% of those patients who should have been declared dead in the field. Shockable initial rhythms, EMS-witnessed arrest, bystander CPR and age were factors significant to predict survival from OHCA without ROSC in the field. Of concern, 1.7% (47) of patients who met TOR presented initially shockable rhythms but no shocks were delivered in the field.

      Conclusions

      We suggest that all treated non-traumatic OHCA patients should be transported to hospital.

      Keywords

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