Out-of-hospital cardiac arrest without return of spontaneous circulation in the field: Who are the survivors?

Pubmed ID: 28012882

Journal: Resuscitation

Publication Date: March 1, 2017

Affiliation: Department of Emergency Medicine, University of Texas, Southwestern Medical Center, 5323 Harry Hines BLVD, Dallas, TX 75390-8579, USA. Electronic address: aidris@sbcglobal.net.

MeSH Terms: Humans, Male, Adult, Female, Aged, Odds Ratio, Age Factors, Logistic Models, Middle Aged, Survival Analysis, Treatment Outcome, Retrospective Studies, Cardiopulmonary Resuscitation, Emergency Medical Services, Out-of-Hospital Cardiac Arrest, Blood Circulation

Authors: Lu Y, Liao X, Zhan H, Xiong Y, Idris A, Guan K, Okoro N, Mitchell D, Dwyer M, Leatham A, Salazar G

Cite As: Xiong Y, Zhan H, Lu Y, Guan K, Okoro N, Mitchell D, Dwyer M, Leatham A, Salazar G, Liao X, Idris A. Out-of-hospital cardiac arrest without return of spontaneous circulation in the field: Who are the survivors? Resuscitation 2017 Mar;112:28-33. Epub 2016 Dec 21.

Studies:

Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation Using an Impedance Valve and Early Versus Delayed Analysis (PRIMED)

Abstract

BACKGROUND: Return of spontaneous circulation (ROSC) in the field is a vital determinant contributing to survival from out-of-hospital cardiac arrest (OHCA). However, nearly one third of survivors at the Dallas-Fort Worth (DFW) Resuscitation Outcomes Consortium (ROC) site did not obtain ROSC in the field. METHODS: A retrospective, observational analysis was performed on all adult patients with non-traumatic OHCA treated on scene and transported to hospital, who did not gain ROSC in the field at DFW ROC site between 2006 through 2011.We described the demographics, pre-hospital characteristics and outcomes of all enrolled cases. Those patients without ROSC in the field, who did and did not meet Termination of Resuscitation (TOR) criteria in the field, were also compared. RESULTS: Among a total of 5099 treated and transported non-traumatic OHCA cases, 83.2% (4243) were included in this study as patients without ROSC gained in the field, of which 66.6% (2827) met TOR criteria but still were treated and transported; 1.9% (79) survived to hospital discharge. Further analysis showed that 39.2% (31) of survivors met TOR rule, accounting for 1.1% of those patients who should have been declared dead in the field. Shockable initial rhythms, EMS-witnessed arrest, bystander CPR and age were factors significant to predict survival from OHCA without ROSC in the field. Of concern, 1.7% (47) of patients who met TOR presented initially shockable rhythms but no shocks were delivered in the field. CONCLUSIONS: We suggest that all treated non-traumatic OHCA patients should be transported to hospital.