Adnet Frederic, Triba Mohamed N, Borron Stephen W, Lapostolle Frederic, Hubert Hervé, Gueugniaud Pierre-Yves, Escutnaire Josephine, Guenin Aurelien, Hoogvorst Astrid, Marbeuf-Gueye Carol, Reuter Paul-Georges, Javaud Nicolas, Vicaut Eric, Chevret Sylvie
AP-HP, Urgences-Samu 93, Hôpital Avicenne, Université Paris 13, 93000 Bobigny, France; Inserm U942, BIOmarkers in CArdioNeuroVAScular diseases (BIOCANVAS), Université Paris 7-Denis Diderot, Paris, France.
CNRS UMR 7244, SBMB Team, University Paris 13, Bobigny, France.
Resuscitation. 2017 Feb;111:74-81. doi: 10.1016/j.resuscitation.2016.11.024. Epub 2016 Dec 14.
Relationship between cardiopulmonary arrest and resuscitation (CPR) durations and survival after out-of-hospital cardiac arrest (OHCA) remain unclear. Our primary aim was to determine the association between survival without neurologic sequelae and cardiac arrest intervals in the setting of witnessed OHCA.
We analyzed 27,301 non-traumatic, witnessed OHCA patients in France included in the national registry from June 1, 2011 through December 1, 2015. We analyzed cardiac arrest intervals, designated as no-flow (NF; from collapse to start of CPR) and low-flow (LF; from start of CPR to cessation of resuscitation) in relation to 30-day survival without sequelae. We determined the influence of recognized prognostic factors (age, gender, initial rhythm, location of cardiac arrest) on this relation.
For the entire cohort, the area delimited by a value of NF greater than 12min (95% confidence interval: 11-13min) and LF greater than 33min (95% confidence interval: 29-45min), yielded a probability of 30-day survival of less than 1%. These sets of values were greatly influenced by initial cardiac arrest rhythm, age, sex and location of cardiac arrest. Extended CPR duration (greater than 40min) in the setting of initial shockable cardiac rhythm is associated with greater than 1% survival with NF less than 18min. The NF interval was highly influential on the LF interval regardless of outcome, whether return of spontaneous circulation (p<0.001) or death (p<0.001).
NF duration must be considered in determining CPR duration in OHCA patients. The knowledge of (NF, LF) curves as function of age, initial rhythm, location of cardiac arrest or gender may aid in decision-making vis-à-vis the termination of CPR or employment of advanced techniques.
院外心脏骤停（OHCA）后心肺骤停与复苏（CPR）持续时间之间的关系以及生存率仍不明确。我们的主要目的是确定在目击OHCA情况下无神经后遗症的生存与心脏骤停间隔之间的关联。
我们分析了2011年6月1日至2015年12月1日纳入法国国家登记处的27301例非创伤性、目击OHCA患者。我们分析了心脏骤停间隔，分为无血流期（NF；从心脏骤停至开始CPR）和低血流期（LF；从开始CPR至复苏终止），并将其与30天无后遗症生存情况相关联。我们确定了公认的预后因素（年龄、性别、初始心律、心脏骤停位置）对这种关系的影响。
对于整个队列，由NF大于12分钟（95%置信区间：11 - 13分钟）和LF大于33分钟（95%置信区间：29 - 45分钟）所界定的区域，30天生存率低于1%。这些数值集受到初始心脏骤停心律、年龄、性别和心脏骤停位置的极大影响。在初始可电击心律情况下，CPR持续时间延长（大于40分钟）且NF小于18分钟时，生存率大于1%。无论结局是自主循环恢复（p<0.001）还是死亡（p<0.001），NF间隔对LF间隔都有高度影响。
在确定OHCA患者的CPR持续时间时必须考虑NF持续时间。了解（NF，LF）曲线随年龄（初始心律、心脏骤停位置或性别）变化的情况，可能有助于在决定终止CPR或采用高级技术方面提供决策依据。
