Kashiura Masahiro, Hamabe Yuichi, Akashi Akiko, Sakurai Atsushi, Tahara Yoshio, Yonemoto Naohiro, Nagao Ken, Yaguchi Arino, Morimura Naoto
Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
Nihon University School of Medicine, Tokyo, Japan.
BMC Anesthesiol. 2017 Apr 21;17(1):59. doi: 10.1186/s12871-017-0351-1.
The duration of cardiopulmonary resuscitation (CPR) is an important factor associated with the outcomes for an out-of-hospital cardiac arrest. However, the appropriate CPR duration remains unclear considering pre- and in-hospital settings. The present study aimed to evaluate the relationship between the CPR duration (including both the pre- and in-hospital duration) and neurologically favorable outcomes 1-month after cardiac arrest.
Data were utilized from a prospective multi-center cohort study of out-of-hospital cardiac arrest patients transported to 67 emergency hospitals between January 2012 and March 2013 in the Kanto area of Japan. A total of 3,353 patients with out-of-hospital cardiac arrest (age ≥18 years) who underwent CPR by emergency medical service personnel and achieved the return of spontaneous circulation in a pre- or in-hospital setting were analyzed. The primary outcome was a 1-month favorable neurological outcome. Logistic regression analysis was performed to estimate the influence of cardiopulmonary resuscitation duration. The CPR duration that achieved a cumulative proportion >99% of cases with a 1-month neurologically favorable outcome was determined.
Of the 3,353 eligible cases, pre-hospital return of spontaneous circulation was obtained in 1,692 cases (50.5%). A total of 279 (8.3%) cases had a 1-month neurologically favorable outcome. The CPR duration was significantly and inversely associated with 1-month neurologically favorable outcomes with adjustment for pre- and in-hospital confounders (adjusted odds ratio: 0.911, per minute, 95% CI: 0.892-0.929, p < 0.001). After 30 min of CPR, the probability of a 1-month neurologically favorable outcome decreased from 8.3 to 0.7%. At 45 min of CPR, the cumulative proportion for a 1-month neurologically favorable outcome reached >99%.
The CPR duration was independently and inversely associated with 1-month neurologically favorable outcomes after out-of-hospital cardiac arrest. The CPR duration required to achieve return of spontaneous circulation in >99% of out-of-hospital cardiac arrest patients with a 1-month favorable neurological outcome was 45 min, considering both pre- and in-hospital settings.
心肺复苏（CPR）的持续时间是与院外心脏骤停结局相关的一个重要因素。然而，考虑到院前和院内情况，合适的CPR持续时间仍不明确。本研究旨在评估CPR持续时间（包括院前和院内持续时间）与心脏骤停后1个月神经功能良好结局之间的关系。
数据来自一项对2012年1月至2013年3月间被转运至日本关东地区67家急救医院的院外心脏骤停患者进行的前瞻性多中心队列研究。共分析了3353例年龄≥18岁、由急救医疗服务人员进行CPR并在院前或院内实现自主循环恢复的院外心脏骤停患者。主要结局是1个月时神经功能良好结局。进行逻辑回归分析以评估心肺复苏持续时间的影响。确定了1个月神经功能良好结局累积比例>99%的病例的CPR持续时间。
在3353例符合条件的病例中，1692例（50.5%）实现了院前自主循环恢复。共有279例（8.3%）病例在1个月时神经功能良好。在对院前和院内混杂因素进行校正后，CPR持续时间与1个月时神经功能良好结局显著负相关（校正比值比：每分钟0.911，95%可信区间：0.892 - 0.929，p < 0.001）。CPR 30分钟后，1个月时神经功能良好结局的概率从8.3%降至0.7%。CPR 45分钟时，1个月时神经功能良好结局的累积比例达到>99%。
CPR持续时间与院外心脏骤停后1个月神经功能良好结局独立且呈负相关。考虑到院前和院内情况，在>99%的院外心脏骤停患者中实现自主循环恢复且1个月神经功能良好结局所需的CPR持续时间为45分钟。
