Optimal duration and timing of basic-life-support-only intervention for patients with out-of-hospital cardiac arrest

• Published in: Scientific reports Vol. 14; no. 1; p. 6071
• Main Authors: Takei, Yutaka, Toyama, Gen, Takahashi, Tsukasa, Omatsu, Kentaro
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 13.03.2024; Nature Publishing Group UK; Nature Portfolio
• Subjects: Basic life support; Cardiac arrest; Cardiopulmonary Resuscitation - methods; Cohort Studies; Emergency medical service; Emergency Medical Services - methods; Epinephrine; Heart; Humans; Intervention; Multivariate analysis; On-scene; Out-of-hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - therapy; Population studies; Retrospective Studies; Return of spontaneous circulation; Survival; Epinephrine; Out-of-hospital cardiac arrest; On-scene; Basic life support; Emergency medical service; Return of spontaneous circulation
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-56487-3

To elucidate the relationship between the interval from cardiopulmonary resuscitation initiation to return of spontaneous circulation (ROSC) and neurologically favourable 1-month survival in order to determine the appropriate duration of basic life support (BLS) without advanced interventions. This population-based cohort study included patients aged ≥ 18 years with 9132 out-of-hospital cardiac arrest of presumed cardiac origin who were bystander-witnessed and had achieved ROSC between 2018 and 2020. Patients were classified into two groups based on the resuscitation methods as the "BLS-only" and the "BLS with administered epinephrine (BLS-AE)" groups. Receiver operating characteristic (ROC) curve analysis indicated that administering BLS for 9 min yielded the best neurologically outcome for patients with a shockable rhythm [sensitivity, 0.42; specificity, 0.27; area under the ROC curve (AUC), 0.60] in the BLS-only group. Contrastingly, for patients with a non-shockable rhythm, performing BLS for 6 min yielded the best neurologically outcome (sensitivity, 0.65; specificity, 0.43; AUC, 0.63). After propensity score matching, multivariate analysis revealed that BLS-only resuscitation [6.44 (5.34-7.77)] was associated with neurologically favourable 1-month survival. This retrospective study revealed that BLS-only intervention had a significant impact in the initial minutes following CPR initiation. Nevertheless, its effectiveness markedly declined thereafter. The optimal duration for effective BLS-only intervention varied depending on the patient's initial rhythm. Consequently, advanced interventions should be administered within the first few minutes to counteract the diminishing effectiveness of BLS-only intervention.