Matsuyama Tasuku, Kitamura Tetsuhisa, Kiyohara Kosuke, Nishiyama Chika, Nishiuchi Tatsuya, Hayashi Yasuyuki, Kawamura Takashi, Ohta Bon, Iwami Taku
Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
Resuscitation. 2017 Apr;113:1-7. doi: 10.1016/j.resuscitation.2017.01.005. Epub 2017 Jan 18.
The optimal cardiopulmonary resuscitation (CPR) duration for patients with out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to assess the association between CPR duration and outcome after OHCA.
This prospective, population-based observational study conducted in Osaka, Japan enrolled 6981 adult patients with non-traumatic witnessed OHCA who achieved return of spontaneous circulation (ROSC) from January 2005 through December 2012. CPR duration was defined as the time of CPR initiation by emergency medical service personnel to the ROSC in pre-hospital settings or after hospital admission. The primary outcome was one-month survival with neurologically favourable outcome (cerebral performance category scale 1 or 2).
Overall, median CPR duration was 25min (interquartile range: 15-34) and the proportion of neurologically favourable outcome was 12.5% (875/6,981). The proportion of neurologically favourable outcome among the CPR duration ≥31min group was significantly lower compared with that among the 0-5min group (55.1% [320/581] versus 2.2% [54/2424], adjusted odds ratio [AOR] 0.04; 95% confidence interval [CI] 0.03-0.05 in all patients, 78.4% [240/306] versus 11.4% [30/264], AOR 0.04; 95% CI 0.02-0.06 in the shockable group, 29.1% [80/275] versus 1.1% [24/2160], and AOR 0.03; 95% CI 0.02-0.05 in the non-shockable group). The cumulative proportion for neurologically favourable outcome reached 99% after 44, 41, and 43min of CPR in all patients, the shockable group, and the non-shockable group, respectively.
The proportion of patients with neurologically favourable outcome declined with increasing CPR duration, but some OHCA patients could benefit from prolonged CPR duration >30min.
院外心脏骤停（OHCA）患者的最佳心肺复苏（CPR）持续时间仍不明确。我们旨在评估CPR持续时间与OHCA后结局之间的关联。
这项在日本大阪进行的基于人群的前瞻性观察性研究纳入了6981例2005年1月至2012年12月期间非创伤性目击OHCA且实现自主循环恢复（ROSC）的成年患者。CPR持续时间定义为紧急医疗服务人员在院前环境中或入院后开始CPR至ROSC的时间。主要结局是1个月生存且神经功能良好（脑功能分类量表1或2）。
总体而言，CPR持续时间的中位数为25分钟（四分位间距：15 - 34），神经功能良好结局的比例为12.5%（875/6981）。CPR持续时间≥31分钟组中神经功能良好结局的比例显著低于0 - 5分钟组（所有患者中分别为55.1%[320/581]对2.2%[54/2424]，调整优势比[AOR]0.04；95%置信区间[CI]0.03 - 0.05，可除颤心律组中为78.4%[240/306]对11.4%[30/264]，AOR 0.04；95%CI 0.02 - 0.06，不可除颤心律组中为29.1%[80/275]对1.1%[24/2160]，AOR 0.03；95%CI 0.02 - 0.05）。在所有患者、可除颤心律组和不可除颤心律组中，CPR分别进行44、41和43分钟后，神经功能良好结局的累积比例达到99%。
神经功能良好结局患者的比例随CPR持续时间延长而下降，但一些OHCA患者可能从超过30分钟的延长CPR持续时间中获益。
