title: Cardiopulmonary resuscitation duration and survival in out-of-hospital cardiac arrest patients.
abstract: Relationship between cardiopulmonary arrest and resuscitation (CPR) durations and survival after out-of-hospital cardiac arrest (OHCA) remain unclear. Our primary aim was to determine the association between survival without neurologic sequelae and cardiac arrest intervals in the setting of witnessed OHCA.
  
  
  
  We analyzed 27,301 non-traumatic, witnessed OHCA patients in France included in the national registry from June 1, 2011 through December 1, 2015. We analyzed cardiac arrest intervals, designated as no-flow (NF; from collapse to start of CPR) and low-flow (LF; from start of CPR to cessation of resuscitation) in relation to 30-day survival without sequelae. We determined the influence of recognized prognostic factors (age, gender, initial rhythm, location of cardiac arrest) on this relation.
  
  
  
  For the entire cohort, the area delimited by a value of NF greater than 12min (95% confidence interval: 11-13min) and LF greater than 33min (95% confidence interval: 29-45min), yielded a probability of 30-day survival of less than 1%. These sets of values were greatly influenced by initial cardiac arrest rhythm, age, sex and location of cardiac arrest. Extended CPR duration (greater than 40min) in the setting of initial shockable cardiac rhythm is associated with greater than 1% survival with NF less than 18min. The NF interval was highly influential on the LF interval regardless of outcome, whether return of spontaneous circulation (p<0.001) or death (p<0.001).
  
  
  
  NF duration must be considered in determining CPR duration in OHCA patients. The knowledge of (NF, LF) curves as function of age, initial rhythm, location of cardiac arrest or gender may aid in decision-making vis-à-vis the termination of CPR or employment of advanced techniques.
authors.affiliation: AP-HP, Urgences-Samu 93, Hôpital Avicenne, Université Paris 13, 93000 Bobigny, France; Inserm U942, BIOmarkers in CArdioNeuroVAScular diseases (BIOCANVAS), Université Paris 7-Denis Diderot, Paris, France. Electronic address: frederic.adnet@avc.aphp.fr.
authors.forename: Frederic
authors.initials: F
authors.lastname: Adnet
authors.affiliation: CNRS UMR 7244, SBMB Team, University Paris 13, Bobigny, France.
authors.forename: Mohamed N
authors.initials: MN
authors.lastname: Triba
authors.affiliation: Department of Emergency Medicine, Texas Tech University Health Sciences Center-El Paso, El Paso, TX, USA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Borron
authors.affiliation: AP-HP, Urgences-Samu 93, Hôpital Avicenne, Université Paris 13, 93000 Bobigny, France; Inserm U942, BIOmarkers in CArdioNeuroVAScular diseases (BIOCANVAS), Université Paris 7-Denis Diderot, Paris, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Lapostolle
authors.affiliation: Public Health Department, University of Lille 2, Loos, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Hubert
authors.affiliation: SAMU, Lyon University Hospital, University of Claude Bernard, Lyon, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Gueugniaud
authors.affiliation: Public Health Department, University of Lille 2, Loos, France.
authors.forename: Josephine
authors.initials: J
authors.lastname: Escutnaire
authors.affiliation: AP-HP, Urgences-Samu 93, Hôpital Avicenne, Université Paris 13, 93000 Bobigny, France; Inserm U942, BIOmarkers in CArdioNeuroVAScular diseases (BIOCANVAS), Université Paris 7-Denis Diderot, Paris, France.
authors.forename: Aurelien
authors.initials: A
authors.lastname: Guenin
authors.affiliation: AP-HP, Urgences-Samu 93, Hôpital Avicenne, Université Paris 13, 93000 Bobigny, France; Inserm U942, BIOmarkers in CArdioNeuroVAScular diseases (BIOCANVAS), Université Paris 7-Denis Diderot, Paris, France.
authors.forename: Astrid
authors.initials: A
authors.lastname: Hoogvorst
authors.affiliation: CNRS UMR 7244, SBMB Team, University Paris 13, Bobigny, France.
authors.forename: Carol
authors.initials: C
authors.lastname: Marbeuf-Gueye
authors.affiliation: AP-HP, Urgences-Samu 93, Hôpital Avicenne, Université Paris 13, 93000 Bobigny, France; Inserm U942, BIOmarkers in CArdioNeuroVAScular diseases (BIOCANVAS), Université Paris 7-Denis Diderot, Paris, France.
authors.forename: Paul-Georges
authors.initials: PG
authors.lastname: Reuter
authors.affiliation: AP-HP, Urgences, Hopital Louis Mourier, 92 Combes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Javaud
authors.affiliation: AP-HP, Unité de Recherche Clinique, Hôpital Fernand Widal, Université Paris 7, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.affiliation: AP-HP, Hôpital Saint Louis, University Paris Diderot, Sorbonne Paris Cité, UMR1153 CRESS, Biostatistics and Clinical Epidemiology Research Team (ECSTRA), F-75010, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiopulmonary resuscitation; Low-flow; Out of hospital cardiac arrest no-flow