Abstract
Aim
Longer emergency medical system cardiopulmonary-resuscitation-to-return of-spontaneous-circulation
(EMS CPR-to-ROSC) interval has been associated with worse hospital discharge outcomes
after out-of-hospital cardiac arrest (OHCA). We hypothesized that this association
extends post-discharge in hospital survivors. We investigated whether pre-arrest co-morbidities
influence the duration of resuscitation.
Methods
We included EMS-treated adult OHCA (January 2009 – December 2016) from British Columbia
Cardiac Arrest Registry linked to provincial databases. Pre-OHCA characteristics were
compared by ≤10, 10–20, and >20 min interval categories. Outcomes included survival
and functional outcomes at hospital discharge and 1- and 3-year survival. We examined
the relationship between CPR-to-ROSC intervals and survival using Kaplan-Meier. We
examined the relationship between the CPR-to-ROSC interval (continuous variable) with
all outcomes using regression models.
Results
Among 10,241 OHCA, 4604 (45%) achieved ROSC, with a median CPR-to-ROSC interval of
15.5 (IQR 9.0–22.9) minutes. Diabetes, chronic kidney disease, and prior myocardial
infarction were associated with longer CPR-to-ROSC intervals. 1245 (12.2%) survived
to hospital discharge. Among hospital survivors, Kaplan-Meier survival at 1- and 3-years
were 92% [95% CI 90–93%] and 84% [95% CI 82–86%] respectively; survival curves stratified
by CPR-to-ROSC intervals were not statistically different. Longer CPR-to-ROSC interval
was non-linearly associated with lower survival and functional outcomes at hospital
discharge but not with post-discharge outcomes.
Conclusion
Longer CPR-to-ROSC interval was associated with lower survival at hospital discharge
and was influenced by pre-arrest co-morbidities. However, these intervals were not
associated with long-term survival or functional outcome among hospital survivors,
suggesting early risk of longer CPR-to-ROSC intervals does not persist.
Keywords
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Article info
Publication history
Published online: November 29, 2022
Accepted:
November 22,
2022
Received in revised form:
November 22,
2022
Received:
August 26,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
