DOI: 10.1161/CIRCULATIONAHA.115.018788
Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest
Running title: Nagao et al.; JCS-ReSS, prehospital resuscitation duration Ken Nagao, MD, PhD1; Hiroshi Nonogi, MD, PhD2; Naohiro Yonemoto, DrPH3; David F. Gaieski, MD4; Noritoshi Ito, MD5; Morimasa Takayama, MD, PhD6; Shinichi Shirai, MD, PhD7; Singo Furuya, MD, PhD8; Sigemasa Tani, MD, PhD9; Takeshi Kimura, MD, PhD10; Keijiro Saku, MD, PhD11 for the Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group* 1
Cardiovascular Center, Nihon University Hospital, Tokyo, Japan; 2Dept of Cardio Cardiology, io olo logy gy,, Shizuoka gy Shiz Sh izuo iz uoka uo k ka General Hospital, Shizuoka, Japan; 3Dept of Epidemiology and Biostatistics, National Center of Medical Neurology and Psychiatry, Tokyo, Japan; 4Dept of Emergency Medicine, Sidney Kimmel Medica College Coll leg egee at T Thomas h mas ho mas Jefferson University, Philadel Philadelphia, elph el phia, PA; 5Dept of Card ph Cardiology, rdio rd i logy, Kawasaki Saiwa Saiwai 6 Hospital, Hosp Ho spital, Kawasaki, sp Kaw Ka wasaki, Japa Japan; p n; Dept p of Cardiology, Sa Sakakibara akakibara Hear Heart artt Institute, Tokyo ar Tokyo, y , Japan; 7Dep Dept off Cardiology, y K y, Kokura okkur u a Memo M Memorial emori rial ial H Hospital, osppita tal, l K Kitakyushu, itaakyyush shhu, JJapan; apan ap n; 8Ca Cardiovascular Card rd diovvasccul ular arr C Center, e te en ter, r N Nihon ihon ih on 9 University Unn Hospital, Hospi pital, Tokyo, Tookyo o, Japan; Japan; Ca Cardiovascular Cardio ovascuulaar C Center, ente en ter, te r Nih Nihon hon Un University niv verssity ty Hos Hospital, osspital pi l , T Tokyo, ok kyo o, Japan; Japa Ja pan; 10De pa Dept Dep pt of of Cardiology, Card rdiiology rd gy, Kyoto gy Kyot Ky oto Un ot Unive University, erssity, K Kyoto, yooto oto, o, Ja Japan; apan an; 11De an Dept of Cardiology, Card Ca rdiolo rd ogy, gy Fukuoka Fuukuokaa University Univerrsi Un sity ty of Sc School cho hool ol ooff Me M Medicine, edi diciine di ne, Fu Fuk Fukuoka, kuok ka, Jap Japan apan an * A complete comp co mple mp lete le te list lis istt of investigators inv nves esti es tiga ti gato ga tors to rs participating par arti tici ti cipa ci pati pa ting ti ng in in the the Japanese Japa Ja pane pa nese ne se Circulation Cir ircculat ullat atio ionn Society io Soci So ciet ci ety with et wiith Resuscitation Science Study (JCS-ReSS) Group is listed in the Supplemental Material Appendix Address for Correspondence: Ken Nagao, MD, PhD Cardiovascular Center, Nihon University Hospital 1-6, Kanda Surugadai, Chiyoda-ku Tokyo, 101-8309, Japan Tel: 81-3-3293-1711 Fax: 81-3-3295-1859 E-mail: [email protected] Journal Subject Term: Cardiopulmonary Resuscitation and Emergency Cardiac Care
1 Downloaded from http://circ.ahajournals.org/ at LA TROBE UNIV on February 27, 2016
DOI: 10.1161/CIRCULATIONAHA.115.018788
Abstract
BackgroundʊDuring out-of-hospital cardiac arrest (OHCA), it is unclear how long prehospital resuscitation efforts should be continued to maximize lives saved. Methods and ResultsʊBetween 2005 and 2012, we enrolled 282,183 adult patients with bystander-witnessed OHCA from the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation (ROSC) in cases achieving prehospital ROSC or from call receipt to hospital arrival in cases not achieving prehospital ROSC. In each of four groups stratified by initial cardiac arrest rhythm (shockable versus non-shockable) and bystander resuscitation (presence versus absence), we calculated minimum prehospital resuscitation duration, defined as the length of resuscitation efforts in minutes required to achieve 99% sensitivity for the primary endpoint, favo orable 30 day favorable 30-day neurological outcome after OHCA. Prehospital resuscitation duration to achieve pprehospital reh e os ospi pita pi tall ta ROSC ranged from 1 to 60 minutes. Longer prehospital resuscitation duration reduced the ikelihood of favo ora r ble neurological outcome (adj jus usted odds ratio, 0.84;; 995% 5% confidence interval likelihood favorable (adjusted interval, 0. .83 8388-0.844) 4).. Although the frequ 4) q ency of favorabl le nneurological eurological ooutcome utcome was sig gnificantly 0.838-0.844). frequency favorable significantly ddifferent iffferent betweenn the the four fouur groups, fo gro rouups, ranging ro rang ginng from fro rom m 220.0% 0..0% % ((shockable/bystander sho ho ock kab blee/bysttanndeer rresuscitation esusscit itatiionn grou oup ou group) 0.9 .9% (non-shockable/bystander (non on n-sho ockab blee/bysttand nder resuscitation nd resu usccitaatioon group) gro ro oup up)) [[P
Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest
Running title: Nagao et al.; JCS-ReSS, prehospital resuscitation duration Ken Nagao, MD, PhD1; Hiroshi Nonogi, MD, PhD2; Naohiro Yonemoto, DrPH3; David F. Gaieski, MD4; Noritoshi Ito, MD5; Morimasa Takayama, MD, PhD6; Shinichi Shirai, MD, PhD7; Singo Furuya, MD, PhD8; Sigemasa Tani, MD, PhD9; Takeshi Kimura, MD, PhD10; Keijiro Saku, MD, PhD11 for the Japanese Circulation Society with Resuscitation Science Study (JCS-ReSS) Group* 1
Cardiovascular Center, Nihon University Hospital, Tokyo, Japan; 2Dept of Cardio Cardiology, io olo logy gy,, Shizuoka gy Shiz Sh izuo iz uoka uo k ka General Hospital, Shizuoka, Japan; 3Dept of Epidemiology and Biostatistics, National Center of Medical Neurology and Psychiatry, Tokyo, Japan; 4Dept of Emergency Medicine, Sidney Kimmel Medica College Coll leg egee at T Thomas h mas ho mas Jefferson University, Philadel Philadelphia, elph el phia, PA; 5Dept of Card ph Cardiology, rdio rd i logy, Kawasaki Saiwa Saiwai 6 Hospital, Hosp Ho spital, Kawasaki, sp Kaw Ka wasaki, Japa Japan; p n; Dept p of Cardiology, Sa Sakakibara akakibara Hear Heart artt Institute, Tokyo ar Tokyo, y , Japan; 7Dep Dept off Cardiology, y K y, Kokura okkur u a Memo M Memorial emori rial ial H Hospital, osppita tal, l K Kitakyushu, itaakyyush shhu, JJapan; apan ap n; 8Ca Cardiovascular Card rd diovvasccul ular arr C Center, e te en ter, r N Nihon ihon ih on 9 University Unn Hospital, Hospi pital, Tokyo, Tookyo o, Japan; Japan; Ca Cardiovascular Cardio ovascuulaar C Center, ente en ter, te r Nih Nihon hon Un University niv verssity ty Hos Hospital, osspital pi l , T Tokyo, ok kyo o, Japan; Japa Ja pan; 10De pa Dept Dep pt of of Cardiology, Card rdiiology rd gy, Kyoto gy Kyot Ky oto Un ot Unive University, erssity, K Kyoto, yooto oto, o, Ja Japan; apan an; 11De an Dept of Cardiology, Card Ca rdiolo rd ogy, gy Fukuoka Fuukuokaa University Univerrsi Un sity ty of Sc School cho hool ol ooff Me M Medicine, edi diciine di ne, Fu Fuk Fukuoka, kuok ka, Jap Japan apan an * A complete comp co mple mp lete le te list lis istt of investigators inv nves esti es tiga ti gato ga tors to rs participating par arti tici ti cipa ci pati pa ting ti ng in in the the Japanese Japa Ja pane pa nese ne se Circulation Cir ircculat ullat atio ionn Society io Soci So ciet ci ety with et wiith Resuscitation Science Study (JCS-ReSS) Group is listed in the Supplemental Material Appendix Address for Correspondence: Ken Nagao, MD, PhD Cardiovascular Center, Nihon University Hospital 1-6, Kanda Surugadai, Chiyoda-ku Tokyo, 101-8309, Japan Tel: 81-3-3293-1711 Fax: 81-3-3295-1859 E-mail: [email protected] Journal Subject Term: Cardiopulmonary Resuscitation and Emergency Cardiac Care
1 Downloaded from http://circ.ahajournals.org/ at LA TROBE UNIV on February 27, 2016
DOI: 10.1161/CIRCULATIONAHA.115.018788
Abstract
BackgroundʊDuring out-of-hospital cardiac arrest (OHCA), it is unclear how long prehospital resuscitation efforts should be continued to maximize lives saved. Methods and ResultsʊBetween 2005 and 2012, we enrolled 282,183 adult patients with bystander-witnessed OHCA from the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation (ROSC) in cases achieving prehospital ROSC or from call receipt to hospital arrival in cases not achieving prehospital ROSC. In each of four groups stratified by initial cardiac arrest rhythm (shockable versus non-shockable) and bystander resuscitation (presence versus absence), we calculated minimum prehospital resuscitation duration, defined as the length of resuscitation efforts in minutes required to achieve 99% sensitivity for the primary endpoint, favo orable 30 day favorable 30-day neurological outcome after OHCA. Prehospital resuscitation duration to achieve pprehospital reh e os ospi pita pi tall ta ROSC ranged from 1 to 60 minutes. Longer prehospital resuscitation duration reduced the ikelihood of favo ora r ble neurological outcome (adj jus usted odds ratio, 0.84;; 995% 5% confidence interval likelihood favorable (adjusted interval, 0. .83 8388-0.844) 4).. Although the frequ 4) q ency of favorabl le nneurological eurological ooutcome utcome was sig gnificantly 0.838-0.844). frequency favorable significantly ddifferent iffferent betweenn the the four fouur groups, fo gro rouups, ranging ro rang ginng from fro rom m 220.0% 0..0% % ((shockable/bystander sho ho ock kab blee/bysttanndeer rresuscitation esusscit itatiionn grou oup ou group) 0.9 .9% (non-shockable/bystander (non on n-sho ockab blee/bysttand nder resuscitation nd resu usccitaatioon group) gro ro oup up)) [[P
