Effective Pre-hospital Care for Out-of-hospital Cardiac Arrest Caused by Respiratory Disease

• Published in: Heart, lung & circulation lung & circulation, 2015-03, Vol.24 (3), p.241-249
• Main Authors: Fukuda, Tatsuma, M.D, Fukuda-Ohashi, Naoko, M.D, Doi, Kent, M.D., Ph.D, Matsubara, Takehiro, M.D., Ph.D, Yahagi, Naoki, M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Adult; Advanced airway management; Aged; Aged, 80 and over; Cardiopulmonary resuscitation; Cardiovascular; Disease-Free Survival; Emergency Medical Services - methods; Epinephrine - administration & dosage; Female; Humans; Male; Middle Aged; Out-of-hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - diagnosis; Out-of-Hospital Cardiac Arrest - etiology; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Prehospital care; Rescue breathing; Respiratory disease; Respiratory Tract Diseases - complications; Respiratory Tract Diseases - diagnosis; Respiratory Tract Diseases - mortality; Respiratory Tract Diseases - therapy; Survival Rate; Vasoconstrictor Agents - administration & dosage
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2014.09.004

Background The relationship between pre-hospital care and the prognosis of out-of-hospital cardiac arrest (OHCA) caused by respiratory disease is unclear. This study aimed to assess the impact of pre-hospital care on the prognosis of OHCA caused by respiratory disease. Methods In a nationwide, population-based, observational study, we enrolled 121,081 adults aged ≥18 years who experienced OHCA from January 1, 2010, to December 31, 2010. The primary endpoint was favourable neurological outcomes. Results Of the 120,256 eligible adult OHCA patients, 7,071 (5.9%) experienced OHCA caused by respiratory disease. Of these 7,071 patients, 3,911 (55.3%) received no cardiopulmonary resuscitation (CPR), 2,403 (34.0%) received chest-compression-only CPR, and 757 (10.7%) received conventional CPR by a bystander. There was no significant difference between the three types of bystander CPR with regard to the neurological outcome (no CPR: OR 0.68, 95%CI 0.39-1.24, p = 0.1951; chest-compression-only CPR: OR 0.68, 95%CI 0.37-1.29, p = 0.2295; and conventional CPR: as a reference). Pre-hospital administration of epinephrine (OR 0.37, 95%CI 0.13-0.85, p = 0.0170) and the implementation of advanced airway management (OR 0.32, 95%CI 0.19-0.52, p < 0.0001) were associated with poor neurological outcomes. Conclusions Even in OHCA caused by respiratory disease, not only pre-hospital epinephrine administration but also pre-hospital advanced airway management and rescue breathing in bystander CPR may not be critical.