Impact of time-to-compression on out-of-hospital cardiac arrest survival outcomes: A national registry study

Jia Ling Goh; Pin Pin Pek; Stephanie Man Chung Fook-Chong; Andrew F W Ho; Fahad Javaid Siddiqui; Benjamin Sieu-Hon Leong; Desmond Ren Hao Mao; Weiming Ng; Ling Tiah; Michael Yih-Chong Chia; Lai Peng Tham; Nur Shahidah; Shalini Arulanandam; Marcus Eng Hock Ong; PAROS Clinical Research Network

doi:10.1016/j.resuscitation.2023.109917

Impact of time-to-compression on out-of-hospital cardiac arrest survival outcomes: A national registry study

Resuscitation. 2023 Sep:190:109917. doi: 10.1016/j.resuscitation.2023.109917. Epub 2023 Jul 26.

Authors

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: jialing.goh@mohh.com.sg.
² Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore.
³ Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore.
⁴ Emergency Medicine Department, National University Hospital, Singapore.
⁵ Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore.
⁶ Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore.
⁷ Accident & Emergency, Changi General Hospital, Singapore.
⁸ Emergency Department, Tan Tock Seng Hospital, Singapore.
⁹ Children's Emergency, KK Women's and Children's Hospital, Singapore.
¹⁰ Department of Emergency Medicine, Singapore General Hospital, Singapore.
¹¹ Medical Department, Singapore Civil Defence Force, Singapore.

PMID: 37506813
DOI: 10.1016/j.resuscitation.2023.109917

Abstract

Objective: We aimed to quantify the association of no-flow interval in out-of-hospital cardiac arrests (OHCA) with the odds of neurologically favorable survival and survival to hospital discharge/ 30th day. Our secondary aim was to explore futility thresholds to guide clinical decisions, such as prehospital termination of resuscitation.

Methods: All OHCAs from 2012 to 2017 in Singapore were extracted. We examined the association between no-flow interval (continuous variable) and survival outcomes using univariate and multivariable logistic regressions. The primary outcome was survival with favorable cerebral performance (Glasgow-Pittsburgh Cerebral Performance Categories 1/2), the secondary outcome was survival to hospital discharge/ 30th day if not discharged. To determine futility thresholds, we plotted the adjusted probability of good neurological outcomes to no-flow interval.

Results: 12,771 OHCAs were analyzed. The per-minute adjusted OR when no-flow interval was incorporated as a continuous variable in the multivariable model was: good neurological function- aOR 0.98 (95%CI: 0.97-0.98); survival to discharge- aOR 0.98 (95%CI: 0.98-0.99). Taking the 1% futility of survival line gave a no-flow interval cutoff of 12 mins (NPV 99%, sensitivity 85% and specificity 42%) overall and 7.5 mins for witnessed arrests.

Conclusion: We demonstrated that prolonged no-flow interval had a significant effect on lower odds of favorable neurological outcomes, with medical futility occurring when no-flow interval was >12 mins (>7.5 mins for witnessed arrest). Our study adds to the literature of the importance of early CPR and EMS response and provided a threshold beyond traditional 'down-times', which could aid clinical decisions in TOR or OHCA management.

Keywords: Cardiopulmonary resuscitation; Neurological outcomes; Out-of-hospital cardiac arrest; Survival outcomes; Time-to-compression.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiopulmonary Resuscitation*
Data Collection
Emergency Medical Services*
Humans
Out-of-Hospital Cardiac Arrest*
Registries