Early Defibrillation and Circulatory Support Can Provide Better Long-Term Outcomes Through Favorable Neurological Recovery in Patients With Out-of-Hospital Cardiac Arrest of Cardiac Origin

Mamoru Hase; Kazufumi Tsuchihashi; Noriyuki Fujii; Kimio Nishizato; Nobuaki Kokubu; Satoshi Nara; Yoshihiko Kurimoto; Akiyoshi Hashimoto; Kikuya Uno; Tetsuji Miura; Nobuyuki Ura; Yasufumi Asai; Kazuaki Shimamoto

doi:10.1253/circj.69.1302

Clinical Investigation

Early Defibrillation and Circulatory Support Can Provide Better Long-Term Outcomes Through Favorable Neurological Recovery in Patients With Out-of-Hospital Cardiac Arrest of Cardiac Origin

Mamoru Hase, Kazufumi Tsuchihashi, Noriyuki Fujii, Kimio Nishizato, Nobuaki Kokubu, Satoshi Nara, Yoshihiko Kurimoto, Akiyoshi Hashimoto, Kikuya Uno, Tetsuji Miura, Nobuyuki Ura, Yasufumi Asai, Kazuaki Shimamoto

Author information

Mamoru Hase
Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
Kazufumi Tsuchihashi
Second Department of Internal Medicine, Sapporo Medical University School of Medicine
Noriyuki Fujii
Second Department of Internal Medicine, Sapporo Medical University School of Medicine
Kimio Nishizato
Second Department of Internal Medicine, Sapporo Medical University School of Medicine
Nobuaki Kokubu
Second Department of Internal Medicine, Sapporo Medical University School of Medicine
Satoshi Nara
Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
Yoshihiko Kurimoto
Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
Akiyoshi Hashimoto
Second Department of Internal Medicine, Sapporo Medical University School of Medicine
Kikuya Uno
Second Department of Internal Medicine, Sapporo Medical University School of Medicine
Tetsuji Miura
Second Department of Internal Medicine, Sapporo Medical University School of Medicine
Nobuyuki Ura
Second Department of Internal Medicine, Sapporo Medical University School of Medicine
Yasufumi Asai
Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
Kazuaki Shimamoto
Second Department of Internal Medicine, Sapporo Medical University School of Medicine

Keywords: Cardiopulmonary bypass, Implantable cardioverter defibrillator, Mild hypothermia, Out-of-hospital cardiac arrest

JOURNAL FREE ACCESS

2005 Volume 69 Issue 11 Pages 1302-1307

DOI https://doi.org/10.1253/circj.69.1302

Details

Abstract

Background Early defibrillation and cardiopulmonary bypass have been postulated to be a promising intervention against out-of-hospital cardiac arrest (OHCA); however, little is known about the long-term prognosis. The effects of early recovery of circulation (ROC) on neurological recovery and the long-term outcome in patients with OHCA were examined. Methods and Results Functional recovery and long-term (22.0±15.3 months) outcome were examined in 100 patients with definite diagnosis of OHCA. Spontaneous circulation recovered in 79% of the patients (using on-site counter shock in 20% of the patients). Cardiopulmonary bypass was performed in 38 of the OHCA patients. The total survival and favorable neurological recovery rates were 40% and 25%, respectively. The patients with favorable recovery obtained early ROC (28.2±16.0 min). Receiver-operating characteristic analysis showed that a period of less than 35 min for ROC was the optimal period for achieving a favorable recovery, with sensitivity of 68% and specificity of 73%. The patients with a prior history of heart failure or reduced left ventricular ejection fraction exhibited more frequent, exacerbated heart failure and ventricular arrhythmias. Conclusions Early ROC using on-site counter shock or cardiopulmonary bypass might result in better long-term outcome in patients with OHCA of cardiac origin. (Circ J 2005; 69: 1302 - 1307)

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