THE TIME-DEPENDENT YIELD OF INVASIVE VS. STANDARD RESUSCITATION STRATEGIES: A SECONDARY ANALYSIS OF THE PRAGUE OUT-OF-HOSPITAL CARDIAC ARREST STUDY
Topic: Acute conditions in cardiology | |
| Type: Presentation - doctors , Number in the programme: 15 | |
| Bělohlávek J.1, Grunau B.2, Rob D.3, Huptych M.4, Pudil J.5, Havránek Š.3, Kaválková P.6, Šmalcová J.7 1 II. Interní klinika, VFN Praha, Praha, 2 Departments of Emergency Medicine, St. Paul’s Hospital and the University of British Columbia, Vancouver, Canada, 3 II. interní klinika, VFN Praha, Praha, 4 BioDat Research Group, Oddělení kybernetiky, FEL, ČVUT, 5 II. interní klinika - klinika kardiologie a angiologie, Všeobecná fakultní nemocnice v Praze, Praha, 6 III. Interní klinika, VFN Praha, Praha, 7 II. interní klinika, Všeobecná fakultní nemocnice a 1.LF UK Praha, Prague | |
Background: It is unclear how invasive resuscitative protocols may impact the time-dependent prognosis of out-of-hospital cardiac arrest (OHCA) resuscitations, or the relationship between intra-arrest transport and outcomes. Methods: We performed a secondary analysis of the Prague OHCA Study, which randomized refractory OHCAs to “invasive” (intra-arrest transport for possible ECPR initiation) vs. “standard” resuscitation strategies (predominantly performed on-scene). Between groups, we compared outcomes of the initial resuscitation and 180- and 30-day favourable neurological outcomes (CPC 1–2), and within categories based on resuscitation duration (collapse-to-ROSC/ECPR interval). We plotted the dynamic probability of favourable outcomes with increasing durations of unsuccessful resuscitation. Results: Among invasive and standard groups, respectively: 34/124 (27%) vs. 58/132 (44%) had sustained ROSC (difference _17%, 95%CI _5.0, _28); 38/124 (31%) vs. 24/132 (18%) had 30-day favourable neurological outcomes (difference 12%; 95%CI 2.0, 23); and 39/124 (31%) vs. 29/132 (22%) had 180-day favourable neurological outcomes (difference 9.5%; 95%CI _1.3, 20). For favourable outcome cases: standard group resuscitation durations were right-skewed within the first 60 min; for the invasive group the distribution was bimodal, extending to 77 min. For invasive- and standard-treated cases, the probability of favourable outcomes among those in refractory arrest at 30 min was 28% and 7.6%, respectively; declining to 0% at 77 and 60 min. Conclusion: In comparison to standard resuscitation, invasive strategy cases had fewer achieve sustained ROSC, however improved overall 30- day favourable neurological outcomes. While standard resuscitation yield was limited to < 60 min, invasive protocols offer a second extended window of potential successful resuscitation. Keywords: Cardiopulmonary resuscitation, Heart arrest, Extracorporeal membrane oxygenation, Out-of-Hospital Cardiac Arrest | |
