Survival and Rearrest in out-of-Hospital Cardiac Arrest Patients with Prehospital Return of Spontaneous Circulation: A Prospective Multi-Regional Observational Study.
Prehospital Emergency Care · 2020-02-25 · Observational study
Abstract
OBJECTIVE: We aimed to determine the factors associated with rearrest after prehospital return of spontaneous circulation (ROSC) and examine the factors associated with survival despite rearrest. METHODS: We conducted a prospective multi-regional observational study of out-of-hospital cardiac arrest (OHCA) patients between August 2015 and July 2016. Patients received prehospital advanced cardiovascular life support performed by emergency medical technicians (EMTs). EMTs were directly supervised by medical directors (physicians) via real-time smartphone video calls [Smart Advanced Life Support (SALS)]. The study participants were categorized into rearrest (+) and rearrest (-) groups depending on whether rearrest occurred after prehospital ROSC. After rearrest, patients were further classified as survivors or non-survivors at discharge. RESULTS: SALS was performed in 1,711 OHCA patients. Prehospital ROSC occurred in 345 patients (20.2%); of these patients, 189 (54.8%) experienced rearrest [rearrest (+) group] and 156 did not experience rearrest [rearrest (-) group]. Multivariate analysis showed that a longer interval from collapse to first prehospital ROSC was independently associated with rearrest [odds ratio (OR) 1.081; 95% confidence interval (CI) 1.050-1.114]. The presence of an initial shockable rhythm was independently associated with survival after rearrest (OR 6.920; 95% CI 2.749-17.422). As a predictor of rearrest, the interval from collapse to first prehospital ROSC (cut-off: 24 min) had a sensitivity of 77% and a specificity of 54% (AUC = 0.715 [95% CI 0.661-0.769]). CONCLUSIONS: A longer interval from collapse to first prehospital ROSC was associated with rearrest, and an initial shockable rhythm was associated with survival despite the occurrence of rearrest. Emergency medical service providers and physicians should be prepared to deal with rearrest when pulses are obtained late in the resuscitation.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Medical direction & oversight · Mortality & survival · Paramedics & EMTs · Prehospital physicians · Telemedicine · Time intervals
Related articles
- Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study. (BMJ Open, 2021)
- Cardiac arrest patients in an alpine area during a six year period. (Resuscitation, 2001)
- Use of a Head-Mounted Assisted Reality, High-Resolution Telemedicine Camera and Satellite Communication Terminal in an Out-of-Hospital Cardiac Arrest. (Mayo Clin Proc Digit Health, 2024)
- ReACanROC: Towards the creation of a France-Canada research network for out-of-hospital cardiac arrest. (Resuscitation, 2020)
- Cardiac Outcomes Through Digital Evaluation (CODE) STEMI project: prehospital digitally-assisted reperfusion strategies. (Can J Cardiol, 2012)
- Guideline adherence in acute coronary syndromes between telemedically supported paramedics and conventional on-scene physician care: A longitudinal pre-post intervention cohort study. (Health Informatics J, 2019)