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The association of duration of resuscitation and long-term survival and functional outcomes after out-of-hospital cardiac arrest

  • Jocelyn Chai
    Correspondence
    Corresponding author at: Department of Internal Medicine, University of British Columbia, 899 West 12th Avenue, Vancouver, BC V5Z1M9, Canada.
    Affiliations
    Faculty of Medicine, University of British Columbia, BC, Canada
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  • Christopher B. Fordyce
    Affiliations
    Faculty of Medicine, University of British Columbia, BC, Canada

    Centre for Health Evaluation and Outcome Sciences, University of British Columbia, BC, Canada

    Division of Cardiology, University of British Columbia, BC, Canada
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  • Meijiao Guan
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, University of British Columbia, BC, Canada
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  • Karin Humphries
    Affiliations
    Centre for Health Evaluation and Outcome Sciences, University of British Columbia, BC, Canada

    Division of Cardiology, University of British Columbia, BC, Canada
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  • Jacob Hutton
    Affiliations
    Faculty of Medicine, University of British Columbia, BC, Canada

    British Columbia Emergency Health Services, BC, Canada
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  • Jim Christenson
    Affiliations
    Faculty of Medicine, University of British Columbia, BC, Canada

    Department of Emergency Medicine, University of British Columbia, BC, Canada
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  • Brian Grunau
    Affiliations
    Faculty of Medicine, University of British Columbia, BC, Canada

    Centre for Health Evaluation and Outcome Sciences, University of British Columbia, BC, Canada

    British Columbia Emergency Health Services, BC, Canada

    Department of Emergency Medicine, University of British Columbia, BC, Canada
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      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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