J Korean Med Sci.  2020 Apr;35(16):e108. 10.3346/jkms.2020.35.e108.

Association between Cardiac Arrest Time and Favorable Neurological Outcomes in Witnessed Out-of-Hospital Cardiac Arrest Patients Treated with Targeted Temperature Management

• Lee ZH
• Kim YH
• Lee JH
• Lee DW
• Lee KY
• Hwang SY

• KMID: 2500201
• DOI: http://doi.org/10.3346/jkms.2020.35.e108

Abstract

Background
Patients who achieve a return of spontaneous circulation (ROSC) with prolonged cardiac arrest have been recognized to have a poor prognosis. This might lead to reluctance in the provision of post-resuscitation care. Hence, we evaluated the impact of cardiac arrest time on neurologic outcomes in out-of-hospital cardiac arrest (OHCA) patients.
Methods
This cross-sectional study used a hospital-based nationwide registry of OHCAs in Korea between 2012 and 2016. All witnessed OHCA patients aged ≥ 15 years and treated with targeted temperature management were included. We collected the time from collapse to sustained ROSC, which was defined as the downtime. The primary outcome was a favorable neurological outcome at hospital discharge. A multiple logistic regression analysis was conducted to determine independent factors for primary outcome in patients with downtime > 30 minutes.
Results
Overall, neurologically favorable outcome rates were 30.5% in 1,963 patients. When the downtime was stratified into categories of 0–10, 11–20, 21–30, 31–40, 41–50, 51–60, and > 60 minutes according to 10-minute intervals, neurologically favorable outcome rates were 58.2%, 52.3%, 37.3%, 24.6%, 14.1%, 17.4%, and 16.7%, respectively (P < 0.001). In patients with downtime > 30 minutes, age 51–70 years (odds ratio [OR], 5.35; 95% confidence interval [CI], 2.50–11.49), age ≤ 50 years (OR, 13.16; 95% CI, 6.06–28.57), shockable rhythm (OR, 3.92; 95% CI, 2.71–5.68), bystander resuscitation (OR, 1.80; 95% CI, 1.27–2.55), cardiac cause (OR, 3.50; 95% CI, 1.69–7.25), percutaneous coronary intervention (OR, 1.82; 95% CI, 1.18–2.81), and downtime ≤ 40 minutes (OR, 2.02; 95% CI, 1.42–2.88) were associated with favorable neurological outcomes.
Conclusion
In patients with prolonged downtime, predicting favorable neurologic outcome may be multifactorial. The cutoff value for downtime is not the only determining factor to provide post-resuscitation care.

Keyword

Out-of-Hospital Cardiac Arrest; Targeted Temperature Management; Outcome

Figure

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  Fig. 1 Study flowchart.OHCA = out-of-hospital cardiac arrest, ROSC = return of spontaneous circulation, ED = emergency department, TTM = targeted temperature management, CPC = cerebral performance category.

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  Fig. 2 Relationship between duration of downtime and favorable neurological outcome according to stratified cardiopulmonary resuscitation variables. (A) Initial rhythms. (B) Bystander CPR. (C) Age. (D) Causes of arrest. (E) PCI.CPR = cardiopulmonary resuscitation, PCI = percutaneous coronary intervention.*Significant differences between strata according to cardiopulmonary resuscitation variables.

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