Predictors of Out of Hospital Cardiac Arrest Outcomes in Pre-Hospital Settings; a Retrospective Cross-sectional Study

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Abstract

Introduction:

Different potential factors can affect the outcomes of Out of Hospital Cardiac Arrest (OHCA). The present study aimed to identify important factors contributing to the Return of Spontaneous Circulation (ROSC) and Survival to Hospital Discharge (SHD) in these patients.

Methods:

This cross-sectional study was conducted on all the OHCA patients who underwent Cardiopulmonary Resuscitation (CPR) in emergency medical service (EMS) of Hamedan province during 2016-2017. All the relevant data were retrieved from three sources, according to Utstein’s style. In addition, univariate and multivariate logistic regressions were employed to identify predictive factors of ROSC and SHD using SPSS software, version 20.

Results:

Among the 3214 eligible patients whose data were collected, most OHCA patients were female (59.7%) with the mean age of 58 years. Moreover, the majority of OHCAs (77.8%) occurred at home during 8pm-8am (65.1%) and about 26.3% of OHCAs were witnessed, with only 5.1% bystander-initiated CPR. Furthermore, the median ambulance response time and CPR duration were 6.0 and 20 minutes, respectively. Overall, ROSC and SHD success rates were 8.3 and 4.1%, respectively. Bystander CPR was found to be the most effective predicting factor for the success rate of ROSC (AOR=3.26, P<0.001) and SHD (AOR=3.04, P<0.001) after adjusting for the Utstein variables including the patients’ age, gender, cardiac disease history, arrest time, CPR duration, response time, being witnessed, bystander CPR, and endotracheal intubation (ETI).

Conclusion:

The overall success rates of ROSC and SHD were 8.3% and 4.1%, respectively. The age, ambulance response time, CPR duration, and cardiac disease history were negatively associated with the outcomes of ROSC and SHD, while being witnessed, bystander CPR, ETI, and initial shockable rhythm were positively related to both of the above-mentioned outcomes.

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Most cited references 35

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Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies?

Clifton Callaway, Jon C Rittenberger, Eric C. Reynolds … (2013)

Functionally favorable survival remains low after out-of-hospital cardiac arrest. When initial interventions fail to achieve the return of spontaneous circulation, they are repeated with little incremental benefit. Patients without rapid return of spontaneous circulation do not typically survive with good functional outcome. Novel approaches to out-of-hospital cardiac arrest have yielded functionally favorable survival in patients for whom traditional measures had failed, but the optimal transition point from traditional measures to novel therapies is ill defined. Our objective was to estimate the dynamic probability of survival and functional recovery as a function of resuscitation effort duration to identify this transition point. Retrospective cohort study of a cardiac arrest database at a single site. We included 1014 adult (≥18 years) patients experiencing nontraumatic out-of-hospital cardiac arrest between 2005 and 2011, defined as receiving cardiopulmonary resuscitation or defibrillation from a professional provider. We stratified by functional outcome at hospital discharge (modified Rankin scale). Survival to hospital discharge was 11%, but only 6% had a modified Rankin scale of 0 to 3. Within 16.1 minutes of cardiopulmonary resuscitation, 89.7% (95% confidence interval, 80.3%-95.8%) of patients with good functional outcome had achieved return of spontaneous circulation, and the probability of good functional recovery fell to 1%. Adjusting for prehospital and inpatient covariates, cardiopulmonary resuscitation duration (minutes) is independently associated with favorable functional status at hospital discharge (odds ratio, 0.84; 95% confidence interval, 0.72-0.98; P=0.02). The probability of survival to hospital discharge with a modified Rankin scale of 0 to 3 declines rapidly with each minute of cardiopulmonary resuscitation. Novel strategies should be tested early after cardiac arrest rather than after the complete failure of traditional measures.

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Relationship Between the Duration of Cardiopulmonary Resuscitation and Favorable Neurological Outcomes After Out‐of‐Hospital Cardiac Arrest: A Prospective, Nationwide, Population‐Based Cohort Study

Yoshikazu Goto, Akira Funada, Yumiko Nakatsu-Goto (2016)

Background The determination of appropriate duration of in‐the‐field cardiopulmonary resuscitation (CPR) for out‐of‐hospital cardiac arrest (OHCA) patients is one of the biggest challenges for emergency medical service providers and clinicians. The appropriate CPR duration before termination of resuscitation remains unclear and may differ based on initial rhythm. We aimed to determine the relationship between CPR duration and post‐OHCA outcomes. Methods and Results We analyzed the records of 17 238 OHCA patients (age ≥18 years) who achieved prehospital return of spontaneous circulation. Data were prospectively recorded in a nationwide, Japanese database between 2011 and 2012. The time from CPR initiation to prehospital return of spontaneous circulation (CPR duration) was calculated. The primary end point was 1‐month survival with favorable neurological outcomes (Cerebral Performance Category [CPC] scale; CPC 1–2). The 1‐month CPC 1–2 rate was 21.8% (n=3771). CPR duration was inversely associated with 1‐month CPC 1–2 (adjusted unit odds ratio: 0.95, 95% CI: 0.94–0.95). Among all patients, a cumulative proportion of >99% of 1‐month CPC 1–2 was achieved with a CPR duration of 35 minutes. When sorted by the initial rhythm, the CPR duration producing more than 99% of survivors with CPC 1–2 was 35 minutes for shockable rhythms and pulseless electrical activity, and 42 minutes for asystole. Conclusions CPR duration was independently and inversely associated with favorable 1‐month neurological outcomes. The critical prehospital CPR duration for OHCA was 35 minutes in patients with initial shockable rhythms and pulseless electrical activity, and 42 minutes in those with initial asystole.

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Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: A systematic review and meta-analysis.

Mikkel S Andersen, Michael W. Donnino, Lars Andersen … (2017)

To systematically review studies comparing bystander automated external defibrillator (AED) use to no AED use in regard to clinical outcomes in out-of-hospital cardiac arrest (OHCA), and to provide a descriptive summary of studies on the cost-effectiveness of bystander AED use.

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Author and article information

Journal

Journal ID (nlm-ta): Arch Acad Emerg Med

Journal ID (iso-abbrev): Arch Acad Emerg Med

Journal ID (publisher-id): AAEM

Title: Archives of Academic Emergency Medicine

Publisher: Shahid Beheshti University of Medical Sciences (Tehran, Iran )

ISSN (Electronic): 2645-4904

Publication date Collection: 2019

Publication date (Electronic): 10 July 2019

Volume: 7

Issue: 1

Electronic Location Identifier: 36

Affiliations

[1 ]Critical Care and Geriatric Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.

[2 ] Student Research Committee, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

[3 ]Emergency Department, Besat Hospital, Hamedan University of Medical Sciences, Hamedan, Iran.

[4 ]Intensive Care and Management Nursing Department, School of Nursing and Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran.

[5 ]Professor of Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, School of Public Health, Hamedan University of Medical Sciences, Hamedan, Iran.

Author notes

[* ]Corresponding author: Afshin Khazaei; School of Nursing and Midwifery, Shahid Fahmideh Blvd, Hamedan, Iran. Postal code: 141973317. Email: khazaei-a@razi.tums.ac.ir, Tel: 00989183143075

Article

Publisher ID: aaem-7-e36

PMC ID: 6732204

PubMed ID: 31555766

SO-VID: d9ee9e2c-3968-429d-ae05-a5b2e01e365a

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Predictors of Out of Hospital Cardiac Arrest Outcomes in Pre-Hospital Settings; a Retrospective Cross-sectional Study

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Abstract

Introduction:

Methods:

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NTT Journal for Theology and the Study of Religion

Most cited references 35

Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies?

Relationship Between the Duration of Cardiopulmonary Resuscitation and Favorable Neurological Outcomes After Out‐of‐Hospital Cardiac Arrest: A Prospective, Nationwide, Population‐Based Cohort Study

Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: A systematic review and meta-analysis.

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