For OHCA, ongoing CPR upon hospital arrival is not always a death sentence

  • Gregers E & al.
  • Crit Care
  • 29 Sep 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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).

Limitations

  • Small retrospective study.
  • Data on distance to hospital lacking.

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