How long is long enough? Good neurologic outcome in out-of-hospital cardiac arrest survivors despite prolonged resuscita
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ORIGINAL PAPER
How long is long enough? Good neurologic outcome in out‑of‑hospital cardiac arrest survivors despite prolonged resuscitation: a retrospective cohort study Simon Braumann1 · Felix Sebastian Nettersheim1 · Christopher Hohmann1 · Tobias Tichelbäcker1 · Martin Hellmich2 · Anton Sabashnikov3 · Ilija Djordjevic3 · Joana Adler1 · Richard Julius Nies1 · Dennis Mehrkens1 · Samuel Lee1 · Robert Stangl4 · Hannes Reuter1,5 · Stephan Baldus1 · Christoph Adler1,4 Received: 11 January 2020 / Accepted: 26 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Despite all efforts, mortality of out of hospital cardiac arrest (OHCA) remains high. Patients with OHCA due to a primary shockable rhythm typically have a better prognosis. However, outcome worsens if return of spontaneous circulation (ROSC) cannot be achieved quickly. There is insufficient evidence for maximum duration of resuscitation in these patients and it is unclear, which patients profit from transport under ongoing CPR. Objective Investigate predictors for favourable neurologic outcome in OHCA patients with presumed cardiac cause due to refractory shockable rhythm (rSR). Methods Retrospective analysis of OHCA patients that presented to a tertiary hospital due to a rSR. Results One hundred seventy-five OHCA patients with presumed cardiac cause due to rSR were included. Overall hospital mortality was 50% and 83% of initial survivors were discharged with a good neurologic outcome [cerebral performance category (CPC) 1–2]. In patients with a time from cardiac arrest to ROSC of > 45 min, 18% survived to CPC 1–2. Independent predictors for good neurologic outcome were age, lower no-flow time and lower serum lactate levels at hospital arrival. Conclusion In an urban setting, a significant proportion of OHCA patients with rSR can survive to a good neurologic outcome, despite very long time to ROSC. Graphic abstract
Keywords OHCA · Refractory cardiac arrest · Refractory shockable rhythm · Ongoing CPR · Neurologic outcome
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Introduction The incidence of out of hospital cardiac arrest (OHCA) treated with cardiopulmonary resuscitation (CPR) is estimated to be 49 patients per 100,000 population or 363,000 cases/year in Europe [1]. It is widely accepted that factors such as short no-flow time due to bystander CPR, early defibrillation when indicated and a short response time of emergency medical services (EMS) improve overall survival and lead to a favourable neurologic outcome in OHCA patients [2–4]. Despite this recent progress in OHCA treatment, mortality rates remain high at up to 90% [1, 5–7]. Cardiac lesions such as acute myocardial infarction (AMI) are the most prevalent forms of non-traumatic OHCA [8]. These patients frequently present with a primary shockable rhythm and have better prognosis than those with asystole or pulseless electrical activity (PEA) [9–11]. Therefore, current guidelines recommend emergency corona
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