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.
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.
Hase
Mamoru
M
Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan. hase@sapmed.ac.jp
Tsuchihashi
Kazufumi
K
Fujii
Noriyuki
N
Nishizato
Kimio
K
Kokubu
Nobuaki
N
Nara
Satoshi
S
Kurimoto
Yoshihiko
Y
Hashimoto
Akiyoshi
A
Uno
Kikuya
K
Miura
Tetsuji
T
Ura
Nobuyuki
N
Asai
Yasufumi
Y
Shimamoto
Kazuaki
K
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