PosterPDF Available

When to stop CPR: Is there a golden hour of resuscitation?

Authors:
  • DRK Rettungsdienst Mittelhessen

Abstract

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. We investigated the influence of CPR-duration and favourable outcome in patients admitted to hospital with return of spontaneous circulation (ROSC).
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): 302311
Article
Full-text available
Abstrak: Terdapat dua permasalahan yang dialami warga yaitu ketika ada warga yang tiba-tiba tidak sadarkan diri, anggota keluarga yang lain lebih memilih untuk menunggu sampai bisa sadar kembali hingga 30 sampai 60 menit, jika tidak sadar, baru memanggil petugas kesehatan dan biasanya kondisi pasien telah meninggal. Permasalahan kedua adalah setelah dinyatakan meninggal, keluarga pasien serta warga juga tidak segera melakukan rukti jenazah secara mandiri, namun menunggu tokoh masyarakat untuk memulai rukti jenazah. Tujuan kegiatan adalah melakukan pendidikan kesehatan, terkait materi henti jantung, dan perawatan jenzah. Metode pelaksanaan kegiatan pengabdian meliputi penyuluhan, simulasi dan praktek langsung dengan sasaran kelompok ibu pengajian serta anggota pimpinan ranting ‘Aisyiah. Kegiatan dihadiri kurang lebih 30 orang. Hasil posttest menunjukkan peningatan pengetahuan tentang penanganan henti jantung (19,3%) dan rukti jenazah dibanding pretes (35,7%). Untuk kemampuan/skill melakukan pertolongan pertama bervariasi dari skor sangat rendah hingga tinggi. Evaluasi dan tindak lanjut yang ditetapkan yaitu melakukan sosialisasi hasil kegiatan kepada warga lain yang tidak bisa hadir, melalui forum pengajian desa.Abstract: There are two problems experienced, namely when there are residents who suddenly become unconscious, other family members prefer to wait until they can regain consciousness for up to 30 to 60 minutes, then call health workers and usually the patient's condition has died. After being declared dead, the patient's family and residents also do not immediately carry out the funeral independently, but wait for community leaders. The aim of the activity is to conduct health education, related to cardiac arrest, and care for dead bodies. Methods include counseling, simulations and hands-on practice with the target group of recitation mothers and members of the leadership of the 'Aisyiah branch. The event was attended by 30 people. The results of the post test showed an increase in knowledge compared to the pretest (19,3% for hearth failure, and 35,7% for post mortem care). The ability to perform first aid varies from very low to high scores. Evaluation and follow-up have been determined by socializing the results of activities through village recitation forums.
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