• Nalin Chokengarmwong, Luis Alfonso Ortiz, Ali Raja, Joshua N Goldstein, Fei Huang, and D Dante Yeh.
• King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
• Am J Emerg Med. 2016 Aug 1; 34 (8): 1595-9.

BackgroundThe success of Closed Chest Cardiopulmonary Resuscitation (CC-CPR) degrades with prolonged times. Open Chest CPR (OC-CPR) is an alternative that may lead to superior coronary and cerebral perfusion. It is critical to determine when continued CC-CPR is unlikely to be successful to justify initiating OC-CPR as rescue therapy. The purpose of this study is to review CC-CPR outcomes to define a time threshold for attempting OC-CPR.MethodsWe identified all adult non-trauma patients diagnosed with cardiac arrest, ventricular fibrillation, ventricular tachycardia and asystole from 1/1/10-12/31/14. We collected demographics, cardiac rhythm, resuscitation duration, survival to hospital discharge and neurological outcome. Using time to ROSC after ED arrival and good neurological outcome, we explored various times as triggers for attempting OC-CPR.ResultsAmong 242 cases of CPR, 205 cases were out-of-hospital cardiac arrest (OHCA). Mean age was 63.7 (±16.9),woman comprised 29.8% (72/242), and median prehospital CPR time was 30 min (20-44). Patients suffering ED arrest had improved ROSC (54.1% vs. 12.7%, p<0.001) and survival to hospital discharge rates (37.8% vs. 2.9%, p<0.001) compared to OHCA. Patients achieving ROSC had median total CPR duration of 18 minutes (10 minutes of pre-hospital CPR) compared with patients without ROSC who had 45 minutes (30 pre-hospital) respectively. No patient receiving > 10 minutes of CPR in the ED survived to hospital discharge.ConclusionIn patients suffering OHCA and requiring CC-CPR in the ED, overall survival rate to good neurologic function is low. OC-CPR could potentially be attempted after 10 minutes of CC-CPR in the ED.Copyright © 2016 Elsevier Inc. All rights reserved.

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