Different impacts of time from collapse to first cardiopulmonary resuscitation on outcomes after witnessed out-of-hospital cardiac arrest in adults

Masahiko Hara, Kenichi Hayashi, Shungo Hikoso, Yasushi Sakata, Tetsuhisa Kitamura

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background - It is well known that cardiopulmonary resuscitation (CPR) should be attempted as early as possible after out-of-hospital cardiac arrest (OHCA). However, it is unclear about the impact of time to CPR on OHCA outcome by first documented rhythm (pulseless ventricular tachycardia/ventricular fibrillation [pVT/VF], pulseless electric activity [PEA], and asystole). Methods and Results - We enrolled 257 354 adult witnessed OHCA patients between 2007 and 2012 from a prospective nationwide population-based cohort database in Japan. We evaluated relationships between time from collapse to first CPR and neurologically favorable 1-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 by first documented rhythm after witnessed OHCA. We used logistic model for the estimation of prognosis. The number of OHCA patients with pVT/VF, PEA, and asystole were 38 661, 96 906, and 121 787, respectively. The overall neurologically favorable 1-month survival rates were 21.3% in patients with pVT/VF, 2.7% PEA, and 0.6% asystole. The proportion of asystole increased as the time from collapse to CPR delayed, whereas those of pVT/VF and PEA decreased (trend P<0.001). Estimated incidences of end-point after OHCA became lower as first CPR delayed irrespective of type of first documented rhythm, but were different by the rhythm. The average percentage point decreases in neurologically favorable 1-month survival probability for each incremental minute of CPR delay were 8.3%, 4.4%, and 6.4% for patients with pVT/VF, PEA, and asystole, respectively. Conclusions - The OHCA outcome differed by time to first CPR and first documented rhythm. Shortening of time to first CPR is crucial for improving the OHCA outcome.

Original languageEnglish
Pages (from-to)277-284
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume8
Issue number3
DOIs
Publication statusPublished - 2015 Jan 1
Externally publishedYes

Fingerprint

Out-of-Hospital Cardiac Arrest
Cardiopulmonary Resuscitation
Ventricular Fibrillation
Ventricular Tachycardia
Heart Arrest
Survival
Japan
Survival Rate
Logistic Models
Databases
Incidence

Keywords

  • cardiopulmonary resuscitation
  • out-of-hospital cardiac arrest
  • ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Different impacts of time from collapse to first cardiopulmonary resuscitation on outcomes after witnessed out-of-hospital cardiac arrest in adults. / Hara, Masahiko; Hayashi, Kenichi; Hikoso, Shungo; Sakata, Yasushi; Kitamura, Tetsuhisa.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 8, No. 3, 01.01.2015, p. 277-284.

Research output: Contribution to journalArticle

Hara, Masahiko ; Hayashi, Kenichi ; Hikoso, Shungo ; Sakata, Yasushi ; Kitamura, Tetsuhisa. / Different impacts of time from collapse to first cardiopulmonary resuscitation on outcomes after witnessed out-of-hospital cardiac arrest in adults. In: Circulation: Cardiovascular Quality and Outcomes. 2015 ; Vol. 8, No. 3. pp. 277-284.
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AU - Hayashi, Kenichi

AU - Hikoso, Shungo

AU - Sakata, Yasushi

AU - Kitamura, Tetsuhisa

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AB - Background - It is well known that cardiopulmonary resuscitation (CPR) should be attempted as early as possible after out-of-hospital cardiac arrest (OHCA). However, it is unclear about the impact of time to CPR on OHCA outcome by first documented rhythm (pulseless ventricular tachycardia/ventricular fibrillation [pVT/VF], pulseless electric activity [PEA], and asystole). Methods and Results - We enrolled 257 354 adult witnessed OHCA patients between 2007 and 2012 from a prospective nationwide population-based cohort database in Japan. We evaluated relationships between time from collapse to first CPR and neurologically favorable 1-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 by first documented rhythm after witnessed OHCA. We used logistic model for the estimation of prognosis. The number of OHCA patients with pVT/VF, PEA, and asystole were 38 661, 96 906, and 121 787, respectively. The overall neurologically favorable 1-month survival rates were 21.3% in patients with pVT/VF, 2.7% PEA, and 0.6% asystole. The proportion of asystole increased as the time from collapse to CPR delayed, whereas those of pVT/VF and PEA decreased (trend P<0.001). Estimated incidences of end-point after OHCA became lower as first CPR delayed irrespective of type of first documented rhythm, but were different by the rhythm. The average percentage point decreases in neurologically favorable 1-month survival probability for each incremental minute of CPR delay were 8.3%, 4.4%, and 6.4% for patients with pVT/VF, PEA, and asystole, respectively. Conclusions - The OHCA outcome differed by time to first CPR and first documented rhythm. Shortening of time to first CPR is crucial for improving the OHCA outcome.

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KW - out-of-hospital cardiac arrest

KW - ventricular fibrillation

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