title: Early defibrillation and circulatory support can provide better long-term outcomes through favorable neurological recovery in patients with out-of-hospital cardiac arrest of cardiac origin.
abstract: BACKGROUND
  Early defibrillation and cardiopulmonary bypass have been postulated to be a promising intervention against out-of-hospital cardiac arrest (OHCA); however, little is known about the long-term prognosis. The effects of early recovery of circulation (ROC) on neurological recovery and the long-term outcome in patients with OHCA were examined.
  
  
  RESULTS
  Functional recovery and long-term (22.0+/-15.3 months) outcome were examined in 100 patients with definite diagnosis of OHCA. Spontaneous circulation recovered in 79% of the patients (using on-site counter shock in 20% of the patients). Cardiopulmonary bypass was performed in 38 of the OHCA patients. The total survival and favorable neurological recovery rates were 40% and 25%, respectively. The patients with favorable recovery obtained early ROC (28.2+/-16.0 min). Receiver-operating characteristic analysis showed that a period of less than 35 min for ROC was the optimal period for achieving a favorable recovery, with sensitivity of 68% and specificity of 73%. The patients with a prior history of heart failure or reduced left ventricular ejection fraction exhibited more frequent, exacerbated heart failure and ventricular arrhythmias.
  
  
  CONCLUSIONS
  Early ROC using on-site counter shock or cardiopulmonary bypass might result in better long-term outcome in patients with OHCA of cardiac origin.
authors.affiliation: Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan. hase@sapmed.ac.jp
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hase
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Tsuchihashi
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Fujii
authors.forename: Kimio
authors.initials: K
authors.lastname: Nishizato
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Kokubu
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nara
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kurimoto
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hashimoto
authors.forename: Kikuya
authors.initials: K
authors.lastname: Uno
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Miura
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ura
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Asai
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimamoto
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D017147:Defibrillators, Implantable; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000628:therapy; D020127:Recovery of Function; D013997:Time Factors