title: Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest.
abstract: BACKGROUND
  During out-of-hospital cardiac arrest, it is unclear how long prehospital resuscitation efforts should be continued to maximize lives saved.
  
  
  RESULTS
  Between 2005 and 2012, we enrolled 282 183 adult patients with bystander-witnessed out-of-hospital cardiac arrest from the All-Japan Utstein Registry. Prehospital resuscitation duration was calculated as the time interval from call receipt to return of spontaneous circulation in cases achieving prehospital return of spontaneous circulation or from call receipt to hospital arrival in cases not achieving prehospital return of spontaneous circulation. In each of 4 groups stratified by initial cardiac arrest rhythm (shockable versus nonshockable) and bystander resuscitation (presence versus absence), we calculated minimum prehospital resuscitation duration, defined as the length of resuscitation efforts in minutes required to achieve ≥99% sensitivity for the primary end point, favorable 30-day neurological outcome after out-of-hospital cardiac arrest. Prehospital resuscitation duration to achieve prehospital return of spontaneous circulation ranged from 1 to 60 minutes. Longer prehospital resuscitation duration reduced the likelihood of favorable neurological outcome (adjusted odds ratio, 0.84; 95% confidence interval, 0.838-0.844). Although the frequency of favorable neurological outcome was significantly different among the 4 groups, ranging from 20.0% (shockable/bystander resuscitation group) to 0.9% (nonshockable/bystander resuscitation group; P<0.001), minimum prehospital resuscitation duration did not differ widely among the 4 groups (40 minutes in the shockable/bystander resuscitation group and the shockable/no bystander resuscitation group, 44 minutes in the nonshockable/bystander resuscitation group, and 45 minutes in the nonshockable/no bystander resuscitation group).
  
  
  CONCLUSIONS
  On the basis of time intervals from the shockable arrest groups, prehospital resuscitation efforts should be continued for at least 40 minutes in all adults with bystander-witnessed out-of-hospital cardiac arrest.
  
  
  BACKGROUND
  URL: http://www.umin.ac.jp/ctr/. Unique identifier: 000009918.
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.). nagao.ken@nihon-c.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.).
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonogi
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.).
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yonemoto
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.).
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.).
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Ito
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.).
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.).
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.).
authors.forename: Singo
authors.initials: S
authors.lastname: Furuya
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.).
authors.forename: Sigemasa
authors.initials: S
authors.lastname: Tani
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.).
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: From Cardiovascular Center (K.N., S.F., S.T.), Nihon University Hospital, Tokyo, Japan; Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan (H.N.); Department of Epidemiology and Biostatistics, National Center of Neurology and Psychiatry, Tokyo, Japan (N.Y.); Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (D.F.G.); Department of Cardiology, Kawasaki Saiwai Hospital, Japan (N.I.); Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.T.); Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.); Department of Cardiology, Kyoto University, Japan (T.K.); and Department of Cardiology, Fukuoka University of School of Medicine, Japan (K.S.).
authors.forename: Keijiro
authors.initials: K
authors.lastname: Saku
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D004554:Electric Countershock / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006336:Heart Massage / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: cardiopulmonary resuscitation; heart arrest; out-of-hospital cardiac arrest; resuscitation