Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac Arrest When Should We Change to Novel Therapies?
Duration of Resuscitation Efforts and Functional Outcome After Out-of-Hospital Cardiac Arrest When Should We Change to Novel Therapies?
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DOI：
10.1161/circulationaha.113.002408
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发表时间：
2013-12-03
期刊：
影响因子：
37.8
通讯作者：
Callaway, Clifton W.
中科院分区：
文献类型：
--
作者：
Reynolds, Joshua C.;Frisch, Adam;Callaway, Clifton W.
背景在院外心脏骤停后，功能良好的存活率仍然很低。当最初的干预措施未能实现自发循环的恢复时，它们会重复进行，但增量效益很小。没有迅速恢复自主循环的患者通常不会存活并获得良好的功能结果。院外心脏骤停的新方法在传统措施失败的患者中产生了功能上的有利生存，但从传统措施到新疗法的最佳过渡点定义不清。我们的目标是估计存活和功能恢复的动态概率作为复苏努力持续时间的函数，以确定这一转折点。方法和结果对单个地点的心脏骤停数据库进行回顾性队列研究。我们纳入了1014名成年患者(18岁)，他们在2005至2011年间经历了非创伤性院外心脏骤停，定义为接受专业提供者的心肺复苏或除颤。我们根据出院时的功能结果(改良的Rankin评分)进行分层。心肺复苏16.1分钟内，89.7%(95%可信区间，80.3%~95.8%)功能恢复正常，功能恢复良好的概率降至1%。调整院前和住院患者的协变量后，心肺复苏持续时间(分钟)与出院时良好的功能状态独立相关(优势比为0.84；95%可信区间为0.72~0.98；P=0.02)。结论改良Rankin评分为0~3分的患者出院后存活至出院的概率随心肺复苏分钟数的增加而迅速下降。新的策略应该在心脏骤停后及早测试，而不是在传统措施完全失败后进行测试。
Background Functionally favorable survival remains low after out-of-hospital cardiac arrest. When initial interventions fail to achieve the return of spontaneous circulation, they are repeated with little incremental benefit. Patients without rapid return of spontaneous circulation do not typically survive with good functional outcome. Novel approaches to out-of-hospital cardiac arrest have yielded functionally favorable survival in patients for whom traditional measures had failed, but the optimal transition point from traditional measures to novel therapies is ill defined. Our objective was to estimate the dynamic probability of survival and functional recovery as a function of resuscitation effort duration to identify this transition point.Methods and Results Retrospective cohort study of a cardiac arrest database at a single site. We included 1014 adult (18 years) patients experiencing nontraumatic out-of-hospital cardiac arrest between 2005 and 2011, defined as receiving cardiopulmonary resuscitation or defibrillation from a professional provider. We stratified by functional outcome at hospital discharge (modified Rankin scale). Survival to hospital discharge was 11%, but only 6% had a modified Rankin scale of 0 to 3. Within 16.1 minutes of cardiopulmonary resuscitation, 89.7% (95% confidence interval, 80.3%-95.8%) of patients with good functional outcome had achieved return of spontaneous circulation, and the probability of good functional recovery fell to 1%. Adjusting for prehospital and inpatient covariates, cardiopulmonary resuscitation duration (minutes) is independently associated with favorable functional status at hospital discharge (odds ratio, 0.84; 95% confidence interval, 0.72-0.98; P=0.02).Conclusions The probability of survival to hospital discharge with a modified Rankin scale of 0 to 3 declines rapidly with each minute of cardiopulmonary resuscitation. Novel strategies should be tested early after cardiac arrest rather than after the complete failure of traditional measures.