Kim Daseul, Yu Jae Yong, Kim Minha, Lee Gun Tak, Shin Sang Do, Hwang Sung Yeon, Jeong Daun
Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115, Irwon-Ro, Gangnam-Ku, Seoul, 06355, Republic of Korea.
Research Institute for Data Science and AI (Artificial Intelligence), Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea.
Sci Rep. 2025 Jan 25;15(1):3245. doi: 10.1038/s41598-025-87757-3.
The optimal duration of on-scene cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients remains uncertain. Determining this critical time period requires outweighing the potential risks associated with intra-arrest transport while minimizing delays in accessing definitive hospital-based treatments. This study evaluated the association between on-scene CPR duration and 30-day neurologically favorable survival based on the transport time interval (TTI) in patients with OHCA. We retrospectively analyzed data from the Korean Cardiac Arrest Research Consortium registry of OHCA, comprising 65 participating hospitals in South Korea, between October 2015 and December 2021. We categorized the patients into Short-TTI (TTI < 10 min) and Long-TTI (TTI ≥ 10 min) groups. Differences in clinical features were adjusted for using propensity score matching (PSM) for TTI. The primary outcome was a 30-day neurologically favorable outcome, defined as cerebral performance category 1 or 2. Multivariable logistic regression was used to determine the variables associated with clinical outcomes. A generalized additive model based on a restricted cubic spline smooth function was utilized to infer the optimal cutoff point for on-scene CPR duration. Of the 6,345 patients, 5,844 PSM pairings were created (Short-TTI: 2,922; Long-TTI: 2,922). The primary outcome was achieved in 7.4% and 9.8% of the patients in Short-TTI and Long-TTI groups, respectively (p = 0.001). Increased on-scene CPR duration was associated with decreased neurologically favorable survival (adjusted odds ratio, 0.94; 95% confidence interval, 0.92-0.96). The optimal on-scene CPR durations in the overall PSM, Short-TTI, and Long-TTI groups were 5.1, 0, and 5.0 min, respectively. An adjusted on-scene CPR duration based on expected transport duration may be beneficial for favorable clinical outcomes in patients with OHCA.
院外心脏骤停（OHCA）患者现场心肺复苏（CPR）的最佳持续时间仍不确定。确定这一关键时间段需要权衡与骤停期间转运相关的潜在风险，同时尽量减少获得确定性医院治疗的延迟。本研究基于OHCA患者的转运时间间隔（TTI）评估了现场CPR持续时间与30天神经功能良好生存之间的关联。我们回顾性分析了韩国心脏骤停研究联盟OHCA登记处的数据，该登记处包括2015年10月至2021年12月期间韩国65家参与医院的数据。我们将患者分为短TTI（TTI＜10分钟）和长TTI（TTI≥10分钟）组。使用TTI的倾向评分匹配（PSM）对临床特征差异进行调整。主要结局是30天神经功能良好结局，定义为脑功能类别1或2。采用多变量逻辑回归确定与临床结局相关的变量。利用基于受限立方样条平滑函数的广义相加模型推断现场CPR持续时间的最佳截断点。在6345例患者中，创建了5844对PSM配对（短TTI：2922例；长TTI：2922例）。短TTI组和长TTI组分别有7.4%和9.8%的患者达到主要结局（p = 0.001）。现场CPR持续时间延长与神经功能良好生存降低相关（调整后的优势比为0.94；95%置信区间为0.92 - 0.96）。总体PSM组、短TTI组和长TTI组的最佳现场CPR持续时间分别为5.1分钟、0分钟和5.0分钟。根据预期转运持续时间调整现场CPR持续时间可能有利于OHCA患者获得良好的临床结局。
