Patients with prehospital return of spontaneous circulation (ROSC) have increased along with the improvement in emergency medical service. The study aimed at investigating the prognostic factors in predicting the outcomes in patients with prehospital ROSC.
Materials and Methods:
The retrospective cohort study enrolled 99 adult, non-traumatic cardiac arrest patients who achieved prehospital ROSC and were admitted to National Taiwan University Hospital from 2012 to 2017. The baseline characteristics, pre-existing comorbidity, prehospital events, in-hospital management, survival to discharge, and neurological outcome were collected and analyzed.
Among the enrolled patients, 63 patients (63.6%) survived to hospital discharge (the survival group) and 36 patients (36.4%) failed (the non-survival group). The survival group had a shorter prehospital CPR duration than the non-survival group (9.1±7.0 min vs. 14.8±10.2 min, p= 0.001). When compared with the non-survival group, the survival group had more patients with witnessed collapse (95% vs. 78%, p= 0.011), shockable rhythm (62% vs. 31%, p= 0.003), therapeutic hypothermia (41% vs. 17%, p= 0.012), and emergent coronary angiography (CAG)(67% vs. 17%, p< 0.001). There were 48 patients (48.5%) with favorable neurological outcome (CPC=1~2) and 51 patients (51.5%) with unfavorable neurological outcome (CPC=3~5). The favorable neurological outcome group had a shorter prehospital CPR duration (9.0±7.1 min vs. 13.3±9.5 min, p= 0.015), and more patients with good pre-arrest CPC status (98% vs. 70%, p<0.001), witnessed collapse (98% vs. 80%, p= 0.006), shockable rhythm (71% vs. 31%, p< 0.001), therapeutic hypothermia (44% vs. 22%, p= 0.018), and emergent CAG(77% vs. 22%, p< 0.001) as compared to the unfavorable neurological outcome group. The prehospital CPR duration, therapeutic hypothermia and emergent CAG were significantly associated with both survival and neurological outcomes after multiple logistic regression analysis.
The prehospital CPR duration, therapeutic hypothermia, and emergent CAG are associated with outcomes in patients with prehospital ROSC.