• Masahiko Hara, Kenichi Hayashi, Shungo Hikoso, Yasushi Sakata, and Tetsuhisa Kitamura.
• From the Department of Cardiovascular Medicine (M.H., S.H., Y.S.), Department of Public Health (K.H.), Department of Medical Therapeutics for Heart Failure (S.H.), and Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine (T.K.), Osaka University Graduate School of Medicine, Suita, Japan. masahikohara@cardiology.med.osaka-u.ac.jp lucky_unatan@yahoo.co.jp.
• Circ Cardiovasc Qual. 2015 May 1; 8 (3): 277-84.

BackgroundIt is well known that cardiopulmonary resuscitation (CPR) should be attempted as early as possible after out-of-hospital cardiac arrest (OHCA). However, it is unclear about the impact of time to CPR on OHCA outcome by first documented rhythm (pulseless ventricular tachycardia/ventricular fibrillation [pVT/VF], pulseless electric activity [PEA], and asystole).Methods And ResultsWe enrolled 257,354 adult witnessed OHCA patients between 2007 and 2012 from a prospective nationwide population-based cohort database in Japan. We evaluated relationships between time from collapse to first CPR and neurologically favorable 1-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 by first documented rhythm after witnessed OHCA. We used logistic model for the estimation of prognosis. The number of OHCA patients with pVT/VF, PEA, and asystole were 38,661, 96,906, and 121,787, respectively. The overall neurologically favorable 1-month survival rates were 21.3% in patients with pVT/VF, 2.7% PEA, and 0.6% asystole. The proportion of asystole increased as the time from collapse to CPR delayed, whereas those of pVT/VF and PEA decreased (trend P<0.001). Estimated incidences of end-point after OHCA became lower as first CPR delayed irrespective of type of first documented rhythm, but were different by the rhythm. The average percentage point decreases in neurologically favorable 1-month survival probability for each incremental minute of CPR delay were 8.3%, 4.4%, and 6.4% for patients with pVT/VF, PEA, and asystole, respectively.ConclusionsThe OHCA outcome differed by time to first CPR and first documented rhythm. Shortening of time to first CPR is crucial for improving the OHCA outcome.© 2015 American Heart Association, Inc.

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