Abstract
Background
At lower ambient temperature, patients with out-of-hospital cardiac arrest (OHCA)
easily experience hypothermia. Hypothermia has shown to improve the rate of successful
return of spontaneous circulation (ROSC) in animal models. We hypothesized that lower
temperature affects the impact of bystander cardiopulmonary resuscitation (CPR) on
the increased odds of a favorable neurological outcome post-OHCA.
Methods
This study used information collected by the prospective, nationwide, Utstein registry
to examine data from 352,689 adult patients who experienced OHCA from 2012 to 2016
in Japan. The primary outcome was a 1-month favorable neurological outcomes. Multivariable
logistic regression analyses were conducted to test the impact of bystander CPR according
to the temperature on the favorable outcome.
Results
A total of 201,111 patients with OHCA were included in the complete case analysis.
The lower temperature group had lower proportions of receiving bystander CPR (46.5
vs. 47.9%) and having favorable outcome (2.1 vs 2.8%) than those in the higher group.
Multivariable analysis revealed that bystander CPR at lower temperatures was significantly
associated with favorable outcomes (adjusted odds ratio, 1.22; 95% CI, 1.09–1.37),
whereas bystander CPR at higher temperatures was not associated with favorable outcomes
(1.02; 0.92–1.13). The nonlinear relationship using a spline curve in the multivariable
model revealed that odds ratio of favorable neurological outcomes associated with
bystander CPR increased as the temperature decreased.
Conclusion
Bystander CPR was associated with favorable neurological outcomes at lower temperatures.
The odds of a favorable outcome associated with bystander CPR increased as the temperature
decreased.
Keywords
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Article info
Publication history
Published online: May 20, 2021
Accepted:
May 12,
2021
Received in revised form:
April 15,
2021
Received:
February 5,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
