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Is initial rhythm in OHCA a predictor of preceding no flow time? Implications for bystander response and ECPR candidacy evaluation
- Source :
- Resuscitation. 128
- Publication Year :
- 2018
-
Abstract
- Objective Shockable cardiac rhythms are associated with improved outcomes among out-of-hospital cardiac arrests (OHCA). Initial cardiac rhythm may also be predictive of a short preceding no-flow duration. We examined the relationship between no-flow duration and initial cardiac rhythm, which may demonstrate the urgency in rescuer response and assist with candidacy evaluation for extracorporeal-cardiopulmonary resuscitation (ECPR). Methods We examined consecutive adult OHCA’s identified by a prospective registry in British Columbia (2005–2016). We included those with witnessed OHCA but no bystander CPR. The variable of interest was no-flow duration, defined as time from 9-1-1 call to EMS arrival. We fit an adjusted logistic regression model to estimate the association of no-flow duration and initial cardiac rhythm. Among those with shockable initial rhythms, we calculated the cumulative proportion with no-flow durations under incremental time cut-offs. Results Of 26 621 EMS-treated OHCA’s, 2532 were included. Overall survival was 13.8%, and 34% had initial shockable rhythms. The probability of having an initial shockable rhythm decreased with increasing no-flow durations (adjusted OR 0.88 per minute, 95% CI 0.85–0.91). Among those found with initial shockable rhythms, 94% (95% CI 92–96%) had a no-flow time under 10 min. Conclusion The odds of a shockable initial rhythm declined with each additional minute of no-flow time, highlighting the importance of early access to defibrillation. Among those with initial shockable rhythms, the preceding no-flow duration was highly likely to be under 10 min, which may inform decisions about ECPR candidacy among select patients with unwitnessed arrests.
- Subjects :
- Male
medicine.medical_specialty
Resuscitation
Emergency Medical Services
Defibrillation
medicine.medical_treatment
Electric Countershock
030204 cardiovascular system & hematology
Emergency Nursing
Logistic regression
No flow time
Time-to-Treatment
03 medical and health sciences
0302 clinical medicine
Rhythm
Extracorporeal Membrane Oxygenation
Heart Rate
medicine
Humans
Extracorporeal cardiopulmonary resuscitation
Prospective Studies
Registries
Aged
Retrospective Studies
Aged, 80 and over
British Columbia
business.industry
030208 emergency & critical care medicine
Middle Aged
Survival Analysis
Cardiopulmonary Resuscitation
Duration (music)
Emergency medicine
Emergency Medicine
Candidacy
Female
Cardiology and Cardiovascular Medicine
business
Out-of-Hospital Cardiac Arrest
Subjects
Details
- ISSN :
- 18731570
- Volume :
- 128
- Database :
- OpenAIRE
- Journal :
- Resuscitation
- Accession number :
- edsair.doi.dedup.....9d368fac4df2cb42a2354210f87e3ca0