Predictive Factors for Failure of At-scene Cardiopulmonary Resuscitation in Adults with Non-Traumatic Out-of-Hospital Cardiac Arrest Predictive Factors for Failure of At-scene CPR in Adults with Non-Traumatic OHCA
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Abstract
OBJECTIVE: To identify the predictive factors of at-scene cardiopulmonary resuscitation (CPR) failure in out-of-hospital cardiac arrest (OHCA) patients.
METHODS: A retrospective single centre, cross-sectional study methodology was employed, which collected from emergency medical services patient care reports of non-traumatic OHCA patients over 18 years old who underwent CPR for at least 20 minutes from 1 January 2017 to 31 December 2024. Univariate and multivariate analyses were employed, along with multiple logistic regression analysis to identify the predictive factors of at-scene CPR failure. Also the odds ratio (OR) and 95% confidence interval were reported.
RESULTS: During the study period, 455 OHCA patients met the inclusion criteria. Statistically significant predictive factors for CPR failure (after at least 20 minutes of CPR conducted at-scene) included: ACLS in OHCA patients (p-value < 0.05); asystole as initial arrest rhythms (adjusted OR = 4.68, 95%CI: 2.48-8.86, p-value < 0.001); unwitnessed arrest (adjusted OR = 3.51, 95%CI: 2.14-5.76, p-value < 0.001); unresponsive pupils (adjusted OR = 4.22, 95%CI: 1.95-9.10, p-value < 0.001); no prehospital advanced airway management (adjusted OR = 7.34, 95%CI: 2.47-21.82, p-value < 0.001); and no prehospital drug administration during CPR – including no amiodarone (adjusted OR = 2.41, 95%CI: 1.15-5.04, p-value = 0.020), and no atropine (adjusted OR = 9.22, 95%CI: 2.22-38.25, p-value = 0.002).
CONCLUSION: The study found 6 predictive factors for identifying failure after CPR for at least 20 minutes at the scene: asystole as the initial arrest rhythm, unwitnessed arrest, unresponsive pupils, no prehospital advanced airway management, and no prehospital administration of amiodarone and atropine during CPR. CPR team leaders may incorporate these factors when deciding when to terminate resuscitation at the scene.
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References
Huabbangyang T, Silakoon A, Papukdee P, Klaiangthong R, Thongpean C, Pralomcharoensuk W, et al. Sustained return of spontaneous circulation following out-of-hospital cardiac arrest; developing a predictive model based on multivariate analysis. Arch Acad Emerg Med 2023;11(1):e33.
Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation 2010;81(11):1479-87.
Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. Heart disease and stroke statistics-2022 update: a report from the American Heart Association. Circulation 2022;145(8):e153-639.
Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, et al. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care 2020;24(1):61.
Važanić D, Prkačin I, Nesek-Adam V, Kurtović B, Rotim C. Out-of-hospital cardiac arrest outcomes - bystander cardiopulmonary resuscitation rate improvement. Acta Clin Croat 2022;61(2):265-72.
Hsu SH, Sun JT, Huang EP, Nishiuchi T, Song KJ, Leong B, et al. The predictive performance of current termination-of-resuscitation rules in patients following out-of-hospital cardiac arrest in Asian countries: a cross-sectional multicentre study. PLoS One 2022;17(8):e0270986.
Lee SCL, Mao DR, Ng YY, Leong BS, Supasaovapak J, Gaerlan FJ, et al. Emergency medical dispatch services across Pan-Asian countries: a web-based survey. BMC Emerg Med 2020;20(1):1.
Gräsner JT, Lefering R, Koster RW, Masterson S, Böttiger BW, Herlitz J, et al. EuReCa TWO study collaborators. European resuscitation council guidelines 2020: epidemiology of cardiac arrest in Europe. Resuscitation 2020;152:39-52.
Huabbangyang T, Soion T, Promdee A, Nguanjinda K, Chamchan A, Chaisorn R, et al. Factors associated with successful resuscitation during out-of-hospital cardiac arrest performed by Surgico Medical Ambulance and Rescue Team (S.M.A.R.T), Division of Emergency Medical Service and Disaster, Faculty of Medicine Vajira Hospital, Navamindradhiraj University. J Med Assoc Thai 2021;104:1-9.
Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 2010;3(1):63-81.
Tran A, Rochwerg B, Fan E, Belohlavek J, Suverein MM, Poll M, et al. Prognostic factors associated with favourable functional outcome among adult patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation 2023;193:110004.
Pramono A, Widyastuti Y, Soenarto Y, Rochmawati E, Sudadi. Predictive factors for cardiopulmonary resuscitation failure. Indian J Palliat Care 2021;27(3):426-30.
Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2020;142 16 suppl 2:S366-468.
Goodarzi A, Sadeghian E, Babaei K, Khodaveisi M. Knowledge, attitude and decision-making of nurses in the resuscitation team towards terminating resuscitation and do-not-resuscitate order. Ethiop J Health Sci 2022;32(2):413-22.
Nas J, Kleinnibbelink G, Hannink G, Navarese EP, van Royen N, de Boer MJ, et al. Diagnostic performance of the basic and advanced life support termination of resuscitation rules: a systematic review and diagnostic meta-analysis. Resuscitation 2020;148:3-13.
Bailey ED, Wydro GC, Cone DC. Termination of resuscitation in the prehospital setting for adult patients suffering nontraumatic cardiac arrest. National Association of EMS Physicians Standards and Clinical Practice Committee. Prehosp Emerg Care 2000;4(2):190-5.
Ayyıldız A, Ayyıldız FA, Yıldırım Ö T, Yıldız G. Investigation of mortality rates and the factors affecting survival in out-of-hospital cardiac arrest patients. Aging Male 2023;26(1):2255013.
Reynolds JC, Frisch A, Rittenberger JC, Callaway CW. Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation 2013;128(23):2488-94.
Sandroni C, Cariou A, Cavallaro F, Cronberg T, Friberg H, Hoedemaekers C, et al. Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Resuscitation 2014;85(12):1779-89.
Tamura T, Namiki J, Sugawara Y, Sekine K, Yo K, Kanaya T, et al. Quantitative assessment of pupillary light reflex for early prediction of outcomes after out-of-hospital cardiac arrest: a multicentre prospective observational study. Resuscitation 2018;131:108-13.
Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med 2021;47(4):369-421.
Yang Z, Liang H, Li J, Qiu S, He Z, Li J, et al. Comparing the efficacy of bag-valve mask, endotracheal intubation, and laryngeal mask airway for subjects with out-of-hospital cardiac arrest: an indirect meta-analysis. Ann Transl Med 2019;7(12):257.
Yuksen C, Phattharapornjaroen P, Kreethep W, Suwanmano C, Jenpanitpong C, Nonnongku R, et al. Bag-valve mask versus endotracheal intubation in out-of-hospital cardiac arrest on return of spontaneous circulation: a national database study. Open Access Emerg Med 2020;12:43-6.
Yang Z, Liu J, Zhu Y, Liu L, Qi W. Comparison of bag-valve-mask ventilation, endotracheal intubation, and supraglottic airway devices for out-of-hospital cardiac arrest: a meta-analysis. Am J Emerg Med 2019;37(3):435-41.
Sugiyama K, Kashiura M, Hamabe Y. Amiodarone and lidocaine for shock refractory ventricular fibrillation or ventricular tachycardia in out-of-hospital cardiac arrest: are they really effective? J Thorac Dis 2016;8(8):E791-3.
Alhenaki A, Alqudah Z, Williams B, Nehme E, Nehme Z. Temporal trends in the incidence and outcomes of shock-refractory ventricular fibrillation out-of-hospital cardiac arrest. Resusc Plus 2024;18:100597.
Huang L, Weil MH, Tang W, Sun S, Pernat A, Snyder D. Comparison of antiarrhythmic agents used in shock-resistant ventricular fibrillation: a systematic review and network meta-analysis. Int J Cardiol 2016;220:540-8.
Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S729-67.
