Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

Shahzleen Rajan; Fredrik Folke; Kristian Kragholm; Carolina Malta Hansen; Christopher B Granger; Steen Møller Hansen; Eric D Peterson; Freddy K Lippert; Kathrine Bach Søndergaard; Lars Køber; Gunnar Hilmar Gislason; Christian Torp-Pedersen; Mads Wissenberg

doi:10.1016/j.resuscitation.2016.05.004

Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

Shahzleen Rajan, Fredrik Folke, Kristian Kragholm, Carolina Malta Hansen, Christopher B Granger, Steen Møller Hansen, Eric D Peterson, Freddy K Lippert, Kathrine Bach Søndergaard, Lars Køber, Gunnar Hilmar Gislason, Christian Torp-Pedersen, Mads Wissenberg

Department of Clinical Medicine

21 Citations (Scopus)

Abstract

AIM: It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return of spontaneous circulation (ROSC).

METHODS: We included 1316 adult OHCA individuals with pre-hospital ROSC (2005-2011) handled by the largest nationwide ambulance provider in Denmark. Patients were stratified into 0-5, 6-10, 11-15, 16-20, 21-25 and >25min of cardiopulmonary resuscitation (CPR) by emergency medical services until ROSC was achieved. Nursing home admission and diagnosis of anoxic brain damage were measured as proxies of poor neurological/functional outcomes.

FINDINGS: Median time from CPR initiation to ROSC was 12min (IQR: 7-18) while 20.4% achieved ROSC after >25min. Overall, 37.5% (494) of the study population achieved 30-day survival. Thirty-day survival was inversely related to minutes of CPR to ROSC: ranging from 59.6% (127/213) for ≤5min to 13.8% (19/138) for >25min. If bystander initiated CPR before ambulance arrival, corresponding values ranged from 70.4% (107/152) to 21.8% (12/55). Of 30-day survivors, patients discharged to own home rather than nursing home ranged from 95.0% (124/127) to 84.7% (18/19), respectively. Of 30-day survivors, patients discharged without diagnosis of anoxic brain damage ranged from 98.4% (125/127) to 73.7% (14/19) for corresponding intervals.

CONCLUSION: Even those requiring prolonged resuscitation duration prior to ROSC had meaningful survival rates with the majority of survivors able to return to live in own homes. These data suggest that prolonged resuscitation is not futile.

Original language	English
Journal	Resuscitation
Volume	105
Pages (from-to)	45-51
Number of pages	7
ISSN	0300-9572
DOIs	https://doi.org/10.1016/j.resuscitation.2016.05.004
Publication status	Published - Aug 2016

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Rajan, S., Folke, F., Kragholm, K., Hansen, C. M., Granger, C. B., Hansen, S. M., Peterson, E. D., Lippert, F. K., Søndergaard, K. B., Køber, L., Gislason, G. H., Torp-Pedersen, C., & Wissenberg, M. (2016). Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest. Resuscitation, 105, 45-51. https://doi.org/10.1016/j.resuscitation.2016.05.004

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title = "Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest",

abstract = "AIM: It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return of spontaneous circulation (ROSC).METHODS: We included 1316 adult OHCA individuals with pre-hospital ROSC (2005-2011) handled by the largest nationwide ambulance provider in Denmark. Patients were stratified into 0-5, 6-10, 11-15, 16-20, 21-25 and >25min of cardiopulmonary resuscitation (CPR) by emergency medical services until ROSC was achieved. Nursing home admission and diagnosis of anoxic brain damage were measured as proxies of poor neurological/functional outcomes.FINDINGS: Median time from CPR initiation to ROSC was 12min (IQR: 7-18) while 20.4% achieved ROSC after >25min. Overall, 37.5% (494) of the study population achieved 30-day survival. Thirty-day survival was inversely related to minutes of CPR to ROSC: ranging from 59.6% (127/213) for ≤5min to 13.8% (19/138) for >25min. If bystander initiated CPR before ambulance arrival, corresponding values ranged from 70.4% (107/152) to 21.8% (12/55). Of 30-day survivors, patients discharged to own home rather than nursing home ranged from 95.0% (124/127) to 84.7% (18/19), respectively. Of 30-day survivors, patients discharged without diagnosis of anoxic brain damage ranged from 98.4% (125/127) to 73.7% (14/19) for corresponding intervals.CONCLUSION: Even those requiring prolonged resuscitation duration prior to ROSC had meaningful survival rates with the majority of survivors able to return to live in own homes. These data suggest that prolonged resuscitation is not futile.",

author = "Shahzleen Rajan and Fredrik Folke and Kristian Kragholm and Hansen, {Carolina Malta} and Granger, {Christopher B} and Hansen, {Steen M{\o}ller} and Peterson, {Eric D} and Lippert, {Freddy K} and S{\o}ndergaard, {Kathrine Bach} and Lars K{\o}ber and Gislason, {Gunnar Hilmar} and Christian Torp-Pedersen and Mads Wissenberg",

year = "2016",

month = aug,

doi = "10.1016/j.resuscitation.2016.05.004",

language = "English",

volume = "105",

pages = "45--51",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

AU - Rajan, Shahzleen

AU - Folke, Fredrik

AU - Kragholm, Kristian

AU - Hansen, Carolina Malta

AU - Granger, Christopher B

AU - Hansen, Steen Møller

AU - Peterson, Eric D

AU - Lippert, Freddy K

AU - Søndergaard, Kathrine Bach

AU - Køber, Lars

AU - Gislason, Gunnar Hilmar

AU - Torp-Pedersen, Christian

AU - Wissenberg, Mads

PY - 2016/8

Y1 - 2016/8

N2 - AIM: It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return of spontaneous circulation (ROSC).METHODS: We included 1316 adult OHCA individuals with pre-hospital ROSC (2005-2011) handled by the largest nationwide ambulance provider in Denmark. Patients were stratified into 0-5, 6-10, 11-15, 16-20, 21-25 and >25min of cardiopulmonary resuscitation (CPR) by emergency medical services until ROSC was achieved. Nursing home admission and diagnosis of anoxic brain damage were measured as proxies of poor neurological/functional outcomes.FINDINGS: Median time from CPR initiation to ROSC was 12min (IQR: 7-18) while 20.4% achieved ROSC after >25min. Overall, 37.5% (494) of the study population achieved 30-day survival. Thirty-day survival was inversely related to minutes of CPR to ROSC: ranging from 59.6% (127/213) for ≤5min to 13.8% (19/138) for >25min. If bystander initiated CPR before ambulance arrival, corresponding values ranged from 70.4% (107/152) to 21.8% (12/55). Of 30-day survivors, patients discharged to own home rather than nursing home ranged from 95.0% (124/127) to 84.7% (18/19), respectively. Of 30-day survivors, patients discharged without diagnosis of anoxic brain damage ranged from 98.4% (125/127) to 73.7% (14/19) for corresponding intervals.CONCLUSION: Even those requiring prolonged resuscitation duration prior to ROSC had meaningful survival rates with the majority of survivors able to return to live in own homes. These data suggest that prolonged resuscitation is not futile.

AB - AIM: It is unclear whether prolonged resuscitation can result in successful outcome following out-of-hospital cardiac arrests (OHCA). We assessed associations between duration of pre-hospital resuscitation on survival and functional outcome following OHCA in patients achieving pre-hospital return of spontaneous circulation (ROSC).METHODS: We included 1316 adult OHCA individuals with pre-hospital ROSC (2005-2011) handled by the largest nationwide ambulance provider in Denmark. Patients were stratified into 0-5, 6-10, 11-15, 16-20, 21-25 and >25min of cardiopulmonary resuscitation (CPR) by emergency medical services until ROSC was achieved. Nursing home admission and diagnosis of anoxic brain damage were measured as proxies of poor neurological/functional outcomes.FINDINGS: Median time from CPR initiation to ROSC was 12min (IQR: 7-18) while 20.4% achieved ROSC after >25min. Overall, 37.5% (494) of the study population achieved 30-day survival. Thirty-day survival was inversely related to minutes of CPR to ROSC: ranging from 59.6% (127/213) for ≤5min to 13.8% (19/138) for >25min. If bystander initiated CPR before ambulance arrival, corresponding values ranged from 70.4% (107/152) to 21.8% (12/55). Of 30-day survivors, patients discharged to own home rather than nursing home ranged from 95.0% (124/127) to 84.7% (18/19), respectively. Of 30-day survivors, patients discharged without diagnosis of anoxic brain damage ranged from 98.4% (125/127) to 73.7% (14/19) for corresponding intervals.CONCLUSION: Even those requiring prolonged resuscitation duration prior to ROSC had meaningful survival rates with the majority of survivors able to return to live in own homes. These data suggest that prolonged resuscitation is not futile.

U2 - 10.1016/j.resuscitation.2016.05.004

DO - 10.1016/j.resuscitation.2016.05.004

M3 - Journal article

C2 - 27224447

SN - 0300-9572

VL - 105

SP - 45

EP - 51

JO - Resuscitation

JF - Resuscitation

ER -

Prolonged cardiopulmonary resuscitation and outcomes after out-of-hospital cardiac arrest

Abstract

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