282 Prognostic Factors for Good Neurologic Outcome in Patients With Prolonged Resuscitation Efforts

282 Prognostic Factors for Good Neurologic Outcome in Patients With Prolonged Resuscitation Efforts

Research Forum Abstracts case of initial shockable cardiac rhythm is associated with survival more than 1% with NF less than 18 minutes. NF interval i...

502KB Sizes 0 Downloads 29 Views

Research Forum Abstracts case of initial shockable cardiac rhythm is associated with survival more than 1% with NF less than 18 minutes. NF interval is highly influential on LF interval (p<0.0001). Conclusion: NF duration must be considered in order to determine the CPR duration in out-of-hospital cardiac arrest patients. The knowledge of (NF, LF) curves as function of age, initial rhythm, location of cardiac arrest or sex may help the physician to decide the withdrawal the CPR or to envisage alternative technique.

282

Prognostic Factors for Good Neurologic Outcome in Patients With Prolonged Resuscitation Efforts

Kim JY, Ahn S, Kim WY/University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of

Study Objective: Neurologically intact survival after cardiac arrest can still occur in patients with prolonged downtime. It is unknown which factors associated with outcome in prolonged downtime patients treated with targeted temperature management (TTM). The present study aimed to determine the factors associated with neurologic intact survival in prolonged downtime, defined as >20 minutes, out-ofhospital cardiac arrest (OHCA) patients. Methods: Multicenter, registry-based, retrospective cohort study conducted in 24 hospitals across South Korea between January 2007 and December 2012. We included adult (18 years) non-traumatic OHCA patients who had prolonged downtime and treated with TTM. We defined downtime as the length of time between the patient being recognized as pulseless and return of spontaneous circulation. Good neurologic outcome defined as a cerebral performance category score of 1 or 2. Results: Of the 930 OHCA patients treated with TTM, 254 were excluded, leaving 676 patients with prolonged downtime entering analysis. Mean age was 56.9 years and 150 patients (22.2%) had good neurologic outcome. After multivariable logistic regression analysis, age <60 years (OR 2.92, 95% CI 1.64 – 5.19), initial shockable rhythm (OR 6.75, 95% CI 4.02 – 11.33), no comorbidity (OR 2.12, 95% CI 1.26 – 3.58), downtime intervals [ORs and 95% CIs 0.59 (0.33 – 1.04), 0.43 (0.21 – 0.87), 0.17 (0.06 – 0.47), and 0.14 (0.03 – 0.52) for 30-39 min, 40-49 min, 50-59 min, and  60 min, respectively], and witnessed arrest (OR 1.88, 95% CI 1.05 – 3.35) were associated with good neurologic outcome. Conclusions: Chance of good neurologic outcome in OHCA patients with prolonged downtime decreased as downtime increases. However young age, shockable rhythm, no previous comorbidity, and witnessed arrest were prognostic factors for good neurologic outcome in patients with prolonged resuscitation efforts.

283

CPR Duration and Survival in Out-of-Hospital Cardiac Arrest Patients

Adnet F, Triba MN, Lapostolle F, Borron SW, Hubert H, Gueugniaud P-Y, Chevret S/APHP, Hopital Avicenne, Bobigny, France, UMR CNRS 7244, Bobigny, France; Texas Tech University HSC, El Paso, TX; University of Lille, Lille, France; Lyon University Hospital, Lyon, France; AP-HP, Biostatistical Team, Hôpital Saint Louis, Paris, France

Study Objectives: Relation between cardiopulmonary resuscitation duration and long-term survival after out-of-hospital cardiac arrest (OHCA) remains unclear. In the current study, our primary aim was to determine the association between long-term survival without neurologic sequelae and values of no-flow (NF) and low-flow (LF) in the setting of witnessed OHCA of medical (non-traumatic) origin. Methods: We analyzed 27,301 non-traumatic out-of-hospital witnessed cardiac arrest patients in France included in the French National Registry of Cardiac Arrest (ReAC registry) from June 1, 2015 through December 1, 2015. We analyzed characteristic times of CPR divided as no-flow and low-flow in relation with survival without sequelae at 28 days. We have determined the influence of recognized prognosis characteristics (age, sex, initial rhythm, location of cardiac arrest) on this relation. Results: For the entire cohort, the area delimitated by the value of NF interval more than 12 minutes and LF interval more than 33 minutes, the probability of 28-day survival without neurologic sequelae was less than 1% (Figure 1). These sets of values were greatly (p<0.001) influenced by initial rhythm of cardiac arrest, age, sex and location of cardiac arrest (Figure 2). Long CPR duration (more than 40 minutes) in

S110 Annals of Emergency Medicine

Volume 68, no. 4s : October 2016