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Dennis Rupp1, Birgit Ploeger2, Andreas Jerrentrup2, Erich Wranze3, Rainer Kunkel1, Heiko Hartmann1, Clemens Kill4
1EMS Mittelhessen, German Red Cross, Marburg, 2 Department of Emergency Medicine, University Hospital Marburg, Marburg, 3County of Marburg-Biedenkopf, Marburg,
4Center of Emergency Medicine, University Hospital Essen, Essen
Purpose of the study:
There is limited data about relationship
between duration of cardiopulmonary
resuscitation (CPR) in out-of-hospital
cardiac arrest (OHCA) and favourable
outcome and also about a maximum
time-period for successful resuscitation
at all[1]. We investigated the influence
of CPR-duration and favourable
outcome in patients admitted to
hospital with return of spontaneous
circulation (ROSC).
When to stop CPR: Is there a golden hour of resuscitation?
Results:
In total n=647 CPR-attempts were recorded, complete data
were available in n=422 cases (100%). Admission with ROSC:
n=171 (40.5%). Discharged alive: n=66 (15.6%), discharged
with CPC 1/2: n=48 (11.3%).
Materials and methods:
Review of the CPR-database of a
county with 252,000 inhabitants from
2014-2016. Data included both
medical records and data of the
internal ECG-storage. The duration of
CPR performed by EMS until time of
first ROSC was determined and
compared to hospital discharge and
neurological favourable outcome
(Cerebral Performance Category CPC
1/2. Analysis with U-test, results as
median (25%/75%/99% percentiles).
Conclusion:
CPR in OHCA might be associated with survival and favourable outcome even when CPR was performed for more than
40 minutes by EMS. If the time from collapse to arrival of EMS is added, there really seems to be a“golden hour of
resuscitation” with any chance of survival. Therefore we recommend not to stop CPR earlier.
Corresponding author:
Dennis Rupp
EMS Mittelhessen, German Red Cross
Am Krekel 41
35039 Marburg, Germany
E-Mail: d.rupp@rdmh.de
0
10
20
30
40
50
60
70
80
90
100
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42
%
Duration of CPR in minutes
CPR-duration until first ROSC
- CPR performed by EMS
Discharged alive (shockable)
Discharged alive (non-shockable)
Group
nCPR-duration until first ROSC
Median (P25/P75/P99)
p-
value
Admission
with ROSC
All
rhythms
171
12:47 (07:28/18:50/44:47)min
Shockable
71 10:20 (04:19/20:17/44:36)min 0.165
Non-
shockable
100
13:21 (08:48/18:37/42:52)min
Discharged
alive
Shockable
42 07:46 (03:45/15:01/40:09)min 0.841
Non-
Shockable
22 08:53 (05:05/11:29/20:56)min
Discharge
status (all rhythms)
CPC1/2
48 06:53 (03:02/11:22/32:47)min <0.001
Death-in-
Hospital
107
14:59 (09:36/21:44/49:19)min
References:
[1] L.L. Bossaert et al. / Resuscitation 95 (2015): 302–311