Outcomes and interventions in patients transported to hospital with ongoing CPR after out-of-hospital cardiac arrest - An observational study

S Schmidbauer; E J Yates; C Andréll; D Bergström; H Olson; G D Perkins; H Friberg

doi:10.1016/j.resplu.2021.100170

Outcomes and interventions in patients transported to hospital with ongoing CPR after out-of-hospital cardiac arrest - An observational study

Resusc Plus. 2021 Oct 16:8:100170. doi: 10.1016/j.resplu.2021.100170. eCollection 2021 Dec.

Authors

S Schmidbauer^{1

2}, E J Yates³, C Andréll^{1

4}, D Bergström¹, H Olson¹, G D Perkins⁵, H Friberg^{1

2}

Affiliations

¹ Center for Cardiac Arrest, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
² Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
³ The Dudley Group NHS Foundation Trust, West Midlands DY1 2HQ, UK.
⁴ Team CPR, Practicum Clinical Skills Centre, Office of Medical Services, Region Skåne, Sweden.
⁵ Warwick Clinical Trials Unit and University Hospitals Birmingham, University of Warwick, Coventry CV4 7AL, UK.

Abstract

Introduction: The main objective was to present characteristics and outcome of patients without sustained field return of spontaneous circulation (ROSC) transported to hospital with ongoing cardiopulmonary resuscitation (CPR). Our secondary objectives were to investigate hospital-based interventions and the performance of the universal Termination of Resuscitation-rule (uTOR).

Methods: In this retrospective observational cohort study, out-of-hospital cardiac arrest (OHCA) patients arriving to the emergency department of a university hospital in Sweden during a six-year period (2010-2015) were identified using a prospectively recorded hospital-based registry. Additional data were retrieved from medical records and from the Swedish cardiopulmonary resuscitation registry.

Results: Among 409 patients transported with ongoing CPR, 7 survived to hospital discharge (1.7%). Hospital-based interventions against a suspected cause of arrest were attempted during ongoing resuscitation in 34 patients (8.3%), of whom 3 survived to hospital discharge. The remaining 4 survivors had spontaneous in-hospital ROSC. Survivors presented with either a shockable rhythm (n = 4) or pulseless electrical activity (n = 3). The uTOR identified non-survivors with a positive predictive value (PPV) of 98.4% and a specificity of 71.4% for termination.

Conclusion: Survival after OHCA where sustained prehospital ROSC is not achieved is rare and available in-hospital interventions are rarely utilised. No patient with asystole as the first recorded rhythm survived. The uTOR identified non-survivors with a PPV of 98.4% but showed poor specificity.

Keywords: Outcome; Reversible causes of cardiac arrest; Transport with ongoing CPR; Transport with ongoing resuscitation.