Abstract：
We aimed to quantify the association of no-flow interval in out-of-hospital cardiac arrests (OHCA) with the odds of neurologically favorable survival and survival to hospital discharge/ 30th day. Our secondary aim was to explore futility thresholds to guide clinical decisions, such as prehospital termination of resuscitation.
All OHCAs from 2012 to 2017 in Singapore were extracted. We examined the association between no-flow interval (continuous variable) and survival outcomes using univariate and multivariable logistic regressions. The primary outcome was survival with favorable cerebral performance (Glasgow-Pittsburgh Cerebral Performance Categories 1/2), the secondary outcome was survival to hospital discharge/ 30th day if not discharged. To determine futility thresholds, we plotted the adjusted probability of good neurological outcomes to no-flow interval.
12,771 OHCAs were analyzed. The per-minute adjusted OR when no-flow interval was incorporated as a continuous variable in the multivariable model was: good neurological function- aOR 0.98 (95%CI: 0.97-0.98); survival to discharge- aOR 0.98 (95%CI: 0.98-0.99). Taking the 1% futility of survival line gave a no-flow interval cutoff of 12 mins (NPV 99%, sensitivity 85% and specificity 42%) overall and 7.5 mins for witnessed arrests.
We demonstrated that prolonged no-flow interval had a significant effect on lower odds of favorable neurological outcomes, with medical futility occurring when no-flow interval was >12 mins (>7.5 mins for witnessed arrest). Our study adds to the literature of the importance of early CPR and EMS response and provided a threshold beyond traditional \'down-times\', which could aid clinical decisions in TOR or OHCA management.
All OHCAs from 2012 to 2017 in Singapore were extracted. We examined the association between no-flow interval (continuous variable) and survival outcomes using univariate and multivariable logistic regressions. The primary outcome was survival with favorable cerebral performance (Glasgow-Pittsburgh Cerebral Performance Categories 1/2), the secondary outcome was survival to hospital discharge/ 30th day if not discharged. To determine futility thresholds, we plotted the adjusted probability of good neurological outcomes to no-flow interval.
12,771 OHCAs were analyzed. The per-minute adjusted OR when no-flow interval was incorporated as a continuous variable in the multivariable model was: good neurological function- aOR 0.98 (95%CI: 0.97-0.98); survival to discharge- aOR 0.98 (95%CI: 0.98-0.99). Taking the 1% futility of survival line gave a no-flow interval cutoff of 12 mins (NPV 99%, sensitivity 85% and specificity 42%) overall and 7.5 mins for witnessed arrests.
We demonstrated that prolonged no-flow interval had a significant effect on lower odds of favorable neurological outcomes, with medical futility occurring when no-flow interval was >12 mins (>7.5 mins for witnessed arrest). Our study adds to the literature of the importance of early CPR and EMS response and provided a threshold beyond traditional \'down-times\', which could aid clinical decisions in TOR or OHCA management.
摘要：
目的：我们旨在量化院外心脏骤停（OHCA）的无血流间隔与神经系统有利生存率和出院/第30天生存率的相关性。我们的次要目标是探索徒劳阈值以指导临床决策，如院前终止复苏。
方法：提取2012-2017年新加坡所有OHCAs。我们使用单变量和多变量逻辑回归检查了无流量间隔（连续变量）与生存结果之间的关联。主要结果是生存和良好的脑表现（格拉斯哥-匹兹堡脑表现分类1/2），次要结局是存活至出院/未出院的第30天.为了确定无用的阈值，我们将良好神经系统结局的校正概率与无血流间期作图.
结果：分析了12,771OHCA。将无血流间期作为连续变量纳入多变量模型时，每分钟调整的OR为：良好的神经功能-aOR0.98（95CI：0.97-0.98）；出院生存率-aOR0.98（95CI：0.98-0.99）。取1%无效的生存线给出了12分钟的无流量间隔截止值(净现值99%，敏感性为85%，特异性为42%），目击逮捕的总体和7.5分钟。
结论：我们证明了延长的无血流间期对较低的良好神经系统结局的几率有显著影响。当无流量间隔>12分钟(目击逮捕>7.5分钟)时，发生医疗无效。我们的研究增加了早期CPR和EMS反应重要性的文献，并提供了超出传统“停机时间”的阈值，这可以帮助TOR或OHCA管理中的临床决策。
方法：提取2012-2017年新加坡所有OHCAs。我们使用单变量和多变量逻辑回归检查了无流量间隔（连续变量）与生存结果之间的关联。主要结果是生存和良好的脑表现（格拉斯哥-匹兹堡脑表现分类1/2），次要结局是存活至出院/未出院的第30天.为了确定无用的阈值，我们将良好神经系统结局的校正概率与无血流间期作图.
结果：分析了12,771OHCA。将无血流间期作为连续变量纳入多变量模型时，每分钟调整的OR为：良好的神经功能-aOR0.98（95CI：0.97-0.98）；出院生存率-aOR0.98（95CI：0.98-0.99）。取1%无效的生存线给出了12分钟的无流量间隔截止值(净现值99%，敏感性为85%，特异性为42%），目击逮捕的总体和7.5分钟。
结论：我们证明了延长的无血流间期对较低的良好神经系统结局的几率有显著影响。当无流量间隔>12分钟(目击逮捕>7.5分钟)时，发生医疗无效。我们的研究增加了早期CPR和EMS反应重要性的文献，并提供了超出传统“停机时间”的阈值，这可以帮助TOR或OHCA管理中的临床决策。
