Different Impacts of Time From Collapse to First Cardiopulmonary Resuscitation on Outcomes After Witnessed Out-of-Hospital Cardiac Arrest in Adults.
BACKGROUND
It is well known that cardiopulmonary resuscitation (CPR) should be attempted as early as possible after out-of-hospital cardiac arrest (OHCA). However, it is unclear about the impact of time to CPR on OHCA outcome by first documented rhythm (pulseless ventricular tachycardia/ventricular fibrillation [pVT/VF], pulseless electric activity [PEA], and asystole).


RESULTS
We enrolled 257,354 adult witnessed OHCA patients between 2007 and 2012 from a prospective nationwide population-based cohort database in Japan. We evaluated relationships between time from collapse to first CPR and neurologically favorable 1-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 by first documented rhythm after witnessed OHCA. We used logistic model for the estimation of prognosis. The number of OHCA patients with pVT/VF, PEA, and asystole were 38,661, 96,906, and 121,787, respectively. The overall neurologically favorable 1-month survival rates were 21.3% in patients with pVT/VF, 2.7% PEA, and 0.6% asystole. The proportion of asystole increased as the time from collapse to CPR delayed, whereas those of pVT/VF and PEA decreased (trend P<0.001). Estimated incidences of end-point after OHCA became lower as first CPR delayed irrespective of type of first documented rhythm, but were different by the rhythm. The average percentage point decreases in neurologically favorable 1-month survival probability for each incremental minute of CPR delay were 8.3%, 4.4%, and 6.4% for patients with pVT/VF, PEA, and asystole, respectively.


CONCLUSIONS
The OHCA outcome differed by time to first CPR and first documented rhythm. Shortening of time to first CPR is crucial for improving the OHCA outcome.
From the Department of Cardiovascular Medicine (M.H., S.H., Y.S.), Department of Public Health (K.H.), Department of Medical Therapeutics for Heart Failure (S.H.), and Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine (T.K.), Osaka University Graduate School of Medicine, Suita, Japan. masahikohara@cardiology.med.osaka-u.ac.jp lucky_unatan@yahoo.co.jp.
Masahiko
M
Hara
From the Department of Cardiovascular Medicine (M.H., S.H., Y.S.), Department of Public Health (K.H.), Department of Medical Therapeutics for Heart Failure (S.H.), and Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine (T.K.), Osaka University Graduate School of Medicine, Suita, Japan.
Kenichi
K
Hayashi
From the Department of Cardiovascular Medicine (M.H., S.H., Y.S.), Department of Public Health (K.H.), Department of Medical Therapeutics for Heart Failure (S.H.), and Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine (T.K.), Osaka University Graduate School of Medicine, Suita, Japan.
Shungo
S
Hikoso
From the Department of Cardiovascular Medicine (M.H., S.H., Y.S.), Department of Public Health (K.H.), Department of Medical Therapeutics for Heart Failure (S.H.), and Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine (T.K.), Osaka University Graduate School of Medicine, Suita, Japan.
Yasushi
Y
Sakata
From the Department of Cardiovascular Medicine (M.H., S.H., Y.S.), Department of Public Health (K.H.), Department of Medical Therapeutics for Heart Failure (S.H.), and Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine (T.K.), Osaka University Graduate School of Medicine, Suita, Japan. masahikohara@cardiology.med.osaka-u.ac.jp lucky_unatan@yahoo.co.jp.
Tetsuhisa
T
Kitamura
D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D013997:Time Factors
cardiopulmonary resuscitation; out-of-hospital cardiac arrest; ventricular fibrillation