Won Young Kim1, Tyler A Giberson2, Amy Uber2, Katherine Berg3, Michael N Cocchi4, Michael W Donnino5. 1. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Republic of Korea. 2. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States. 3. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, United States. 4. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Anesthesia Critical Care, Division of Critical Care, Beth Israel Deaconess Medical Center, United States. 5. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States; Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, United States. Electronic address: mdonnino@bidmc.harvard.edu.
Abstract
BACKGROUND: Previous reports have shown that prolonged duration of resuscitation efforts in out-of-hospital cardiac arrest (OHCA) is associated with poor neurologic outcome. This concept has recently been questioned with advancements in post-cardiac arrest care including the use of therapeutic hypothermia (TH). The aim of this study was to determine the rate of good neurologic outcome based on the duration of resuscitation efforts in OHCA patients treated with TH. METHODS: This prospective, observational, study was conducted between January 2008 and September 2012. Inclusion criteria consisted of adult non-traumatic OHCA patients who were comatose after return of spontaneous circulation (ROSC) and received TH. The primary endpoint was good neurologic outcome defined as a cerebral performance category score of 1 or 2. Downtime was calculated as the length of time between the patient being recognized as pulseless and ROSC. RESULTS: 105 patients were treated with TH and 19 were excluded due to unknown downtime, leaving 86 patients for analysis. The median downtime was 18.5 (10.0-32.3)min and 33 patients (38.0%) had a good neurologic outcome. When downtime was divided into four groups (≤10min, 11-20min, 21-30min, >30min), good neurologic outcomes were 62.5%, 37%, 25%, and 21.7%, respectively (p=0.02). However, even with downtime >20min, 22.9% had a good neurologic outcome, and this percentage increased to 37.5% in patients with an initial shockable rhythm. CONCLUSIONS: Although longer downtime is associated with worse outcome in OHCA patients, we found that comatose patients who have been successfully resuscitated and treated with TH have neurologically intact survival rates of 23% even with downtime >20min.
BACKGROUND: Previous reports have shown that prolonged duration of resuscitation efforts in out-of-hospital cardiac arrest (OHCA) is associated with poor neurologic outcome. This concept has recently been questioned with advancements in post-cardiac arrest care including the use of therapeutic hypothermia (TH). The aim of this study was to determine the rate of good neurologic outcome based on the duration of resuscitation efforts in OHCA patients treated with TH. METHODS: This prospective, observational, study was conducted between January 2008 and September 2012. Inclusion criteria consisted of adult non-traumatic OHCApatients who were comatose after return of spontaneous circulation (ROSC) and received TH. The primary endpoint was good neurologic outcome defined as a cerebral performance category score of 1 or 2. Downtime was calculated as the length of time between the patient being recognized as pulseless and ROSC. RESULTS: 105 patients were treated with TH and 19 were excluded due to unknown downtime, leaving 86 patients for analysis. The median downtime was 18.5 (10.0-32.3)min and 33 patients (38.0%) had a good neurologic outcome. When downtime was divided into four groups (≤10min, 11-20min, 21-30min, >30min), good neurologic outcomes were 62.5%, 37%, 25%, and 21.7%, respectively (p=0.02). However, even with downtime >20min, 22.9% had a good neurologic outcome, and this percentage increased to 37.5% in patients with an initial shockable rhythm. CONCLUSIONS: Although longer downtime is associated with worse outcome in OHCA patients, we found that comatosepatients who have been successfully resuscitated and treated with TH have neurologically intact survival rates of 23% even with downtime >20min.
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