title: Duration of Prehospital Cardiopulmonary Resuscitation and Favorable Neurological Outcomes for Pediatric Out-of-Hospital Cardiac Arrests: A Nationwide, Population-Based Cohort Study.
abstract: BACKGROUND
  The appropriate duration of cardiopulmonary resuscitation (CPR) for pediatric out-of-hospital cardiac arrests (OHCAs) remains unclear and may differ based on initial rhythm. We aimed to determine the relationship between the duration of prehospital CPR by emergency medical services (EMS) personnel and post-OHCA outcomes.
  
  
  METHODS
  We analyzed the records of 12 877 pediatric patients who experienced OHCAs (<18 years of age). Data were recorded in a nationwide Japanese database between 2005 and 2012. Study end points were 30-day survival and 30-day survival with favorable neurological outcomes (Cerebral Performance Category [CPC] scale 1-2). Prehospital EMS-initiated CPR duration was defined as the time from CPR initiation by EMS personnel to prehospital return of spontaneous circulation (ROSC) or to hospital arrival when prehospital ROSC was not achieved during prehospital CPR efforts.
  
  
  RESULTS
  The rates of 30-day survival and 30-day CPC 1 to 2 were 9.1% (n=1167) and 2.5% (n=325), respectively. Prehospital EMS-initiated CPR duration was significantly and inversely associated with 30-day outcomes (adjusted odds ratio for 1-minute increments: 0.94, 95% confidence interval: 0.93-0.95 for survival; adjusted odds ratio: 0.90, 95% confidence interval: 0.88-0.92 for CPC 1-2). The duration of prehospital EMS-initiated CPR, beyond which the chance for favorable outcomes diminished to <1%, was 42 minutes for each key outcome, 30-day survival, and 30-day survival with CPC 1 to 2. When categorized by initial rhythm, the prehospital EMS-initiated CPR durations beyond which the chance for 30-day survival with CPC 1 to 2 diminished to <1% were 39 minutes for shockable rhythms, 42 minutes for pulseless electric activity, and 46 minutes for asystole, respectively. In patients with bystander-initiated CPR, the prehospital CPR duration, beyond which the chance for favorable outcome diminished to <1%, was 46 minutes from call receipt.
  
  
  CONCLUSIONS
  Prehospital EMS-initiated CPR duration for pediatric OHCAs was independently and inversely associated with 30-day favorable outcomes. The duration of prehospital EMS-initiated CPR, beyond which the chance for 30-day favorable outcomes diminished to <1%, was 42 minutes. However, the CPR duration to achieve this proportion of outcomes differed based on initial rhythm. Further research is required to elucidate appropriate CPR duration for pediatric OHCAs, including in-hospital CPR time.
  
  
  BACKGROUND
  URL: https://clinicaltrials.gov. Unique identifier: NCT02432196.
authors: From Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan (Y,G., A.F.); and Department of Cardiology, Yawata Medical Center, Komatsu, Japan (Y.G.). gotoyosh@med.kanazawa-u.ac.jp.
authors: Yoshikazu
authors: Y
authors: Goto
authors: From Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan (Y,G., A.F.); and Department of Cardiology, Yawata Medical Center, Komatsu, Japan (Y.G.).
authors: Akira
authors: A
authors: Funada
authors: From Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan (Y,G., A.F.); and Department of Cardiology, Yawata Medical Center, Komatsu, Japan (Y.G.).
authors: Yumiko
authors: Y
authors: Goto
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012042:Registries; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000503:physiopathology; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000503:physiopathology
keywords: cardiopulmonary resuscitation; epidemiology; heart arrest; resuscitation