- Patients surviving refractory out-of-hospital cardiac arrest (OHCA)—i.e., those receiving ongoing CPR upon hospital arrival—have favorable neurological outcomes at similar rates to those who achieve return of spontaneous circulation (ROSC) in the field.
- Number of refractory OHCA patients needed to treat: 5.
Why this matters
- It can be unclear when to terminate resuscitation efforts for these patients.
- 1393 patients arrived at hospital, 1285 (92%) with ROSC, 108 (8%) with refractory OHCA.
- Of those with refractory OHCA:
- 56 (52%) achieved ROSC in emergency department (ED); and
- 4/28 (14%) requiring resuscitation for >60 minutes achieved ROSC.
- Predictors of refractory OHCA (vs prehospital termination of efforts) included (ORs; 95% CIs):
- Arrest in public: 3.7 (2.3-6.0);
- Witnessed: 4.0 (2.1-7.4); and
- Shockable: 2.9 (1.8-4.5).
- Refractory OHCA vs prehospital ROSC groups:
- 30-day survival: 20% (n=22) vs 42% (n=540) (P<.001 class="">
- Favorable neurological outcome: 86% vs 84% (P=.7).
- 4.9 patients with refractory OHCA required transport with ongoing CPR to save 1.
- Analysis of 3992 adult refractory OHCA patients managed without extracorporeal CPR in Copenhagen, Denmark, 2002-2011.
- Outcomes: refractory OHCA predictors, ROSC in ED, survival.
- Funding: TrygFonden (a Danish foundation).
- Small retrospective study.
- Data on distance to hospital lacking.