Abstract
Background
The “no flow” interval is the time from out-of-hospital cardiac arrest (OHCA) to cardiopulmonary
resuscitation (CPR). Its prognostic value is important to define for prehospital resuscitation
decisions, post-resuscitation care and prognostication, and extracorporeal cardiopulmonary
resuscitation (ECPR) candidacy assessment.
Methods
We examined bystander-witnessed OHCAs without bystander CPR from two Resuscitation
Outcomes Consortium datasets. We used modified Poisson regression to model the relationship
between the no-flow interval (9-1-1 call to professional resuscitation) and favourable
neurological outcome (Modified Rankin Score ≤ 3) at hospital discharge. Furthermore,
we identified the no-flow interval beyond which no patients had a favourable outcome.
We analysed a subgroup to simulate ECPR-treated patients (witnessed arrest, age < 65,
non-asystole initial rhythm, and >30 min until return of circulation).
Results
Of 43,593 cases, we included 7299; 616 (8.4%) had favourable neurological outcomes.
Increasing no-flow interval was inversely associated with favourable neurological
outcomes (adjusted relative risk 0.87, 95% CI 0.85–0.90); the adjusted probability
of a favourable neurological outcome decreased by 13% (95% CI 10–15%) per minute.
No patients (0/7299, 0%; 1-sided 97.5% CI 0–0.051%) had both a no-flow interval >20 min
and a favourable neurological outcome. In the hypothetical ECPR group, 0/152 (0%;
1-sided 97.5% CI 0–2.4%) had both a no-flow interval >10 min and a favourable neurological
outcome.
Conclusions
The probability of a favourable neurological outcome in OHCA decreases by 13% for
every additional minute of no-flow time until high-quality CPR, with the possibility
of favourable outcomes up to 20 min.
Keywords
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Article info
Publication history
Published online: June 15, 2020
Accepted:
June 4,
2020
Received in revised form:
February 11,
2020
Received:
January 8,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
