title: Relationship between duration of prehospital resuscitation and favorable prognosis in ventricular fibrillation.
abstract: OBJECTIVE
  There appears to be an optimal point in balancing the relative benefits of extending the resuscitation time to obtain return of spontaneous circulation in the prehospital setting and the initiation of therapies such as extracorporeal cardiopulmonary resuscitation (CPR). This study investigated how prehospital CPR duration is related to survival and neurologic outcome in ventricular fibrillation (VF) and tried to find the tolerable time for prehospital resuscitation.
  
  
  METHODS
  Out-of-hospital cardiac arrest patients with VF in Funabashi City, Japan, from January 2009 to December 2013 were reviewed. Resuscitation teams that included physicians were dispatched to incident sites. Survival rate at 24 hours and neurologic outcome at 30 days were analyzed with respect to prehospital CPR duration.
  
  
  RESULTS
  A total of 172 patients were evaluated. Seventy-three patients were alive at 24 hours. Thirty-four patients had favorable neurologic outcomes after 30 days. Of the 69 patients who required prolonged prehospital CPR (>30 minutes), 6 were alive at 24 hours, and only 1 had a favorable neurologic outcome at 30 days. Logistic regression model showed that both survival rate at 24 hours and neurologic outcome at 30 days deteriorated with the increase in prehospital CPR duration (both P < .001).
  
  
  CONCLUSIONS
  The prognosis of out-of-hospital cardiac arrest patients with VF deteriorated with the increase in prehospital CPR duration. Favorable results are less likely especially in cases of prolonged prehospital CPR (>30 minutes). Therefore, it may be necessary to consider transportation to a more definitive treatment facility rather than extending conventional CPR in the prehospital setting.
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi City, Chiba, Japan. Electronic address: arimataka64@gmail.com.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Arima
authors.affiliation: Department of Anesthesiology, The Cancer Institute Hospital of JFCR, Koto Ward, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nagata
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi City, Chiba, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Sakaida
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi City, Chiba, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Miura
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi City, Chiba, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kakuchi
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi City, Chiba, Japan.
authors.forename: Katsuki
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi City, Chiba, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Mizushima
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi City, Chiba, Japan.
authors.forename: Azusa
authors.initials: A
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000401:mortality / Q000628:therapy*