Early Predictors of Return of Spontaneous Circulation in Patients Undergoing Cardiopulmonary Resuscitation

Abstract

Introduction Decisions about when to start, how long to continue and how to end cardiopulmonary resuscitation (CPR) are important in the management of these critically ill patients. The aim of our study is to determine the factors that can help in the early prediction of patients in whom spontaneous circulation can be restored during CPR. Methods Patients who had arrest due to non-traumatic causes were included in the study. The patients whose spontaneous circulation (ROSC) was restored in the emergency service and who were hospitalized in intensive care were included in ROSC (+) group, while the patients who did not have ROSC and who became exitus were included in ROSC (-) group. Patients’ demographic characteristics, chronic diseases, places of arrest, admission laboratory values and possible causes of death were compared between ROSC groups. Results This study was conducted with the retrospective examination of 309, 118 (38.2%) female and 191 (61.8%) male, cardiopulmonary arrest cases. ROSC was achieved in 94 (30.4%) of the patients who underwent CPR. It was found that a 0,1 unit increase in pH value increased the probability of ROSC by 38% [OR: 1,38 (95% CI: 1,22-1,55), p<0,0001], while multivariate logistic regression analysis showed that it could be an independent predictor of ROSC and increased the probability of survival by 0,43 times [Corrected OR: 1,43 (95% CI: 1,13-1,83), p=0,0033]. It was also found with multivariate logistic regression analysis that respiratory causes could be an independent predictor of ROSC and increased the probability of survival by 2,76 times [Corrected OR: 3,76 (95% CI=1,49-9,53), p=0,0052]. Discussion and Conclusion In patients who undergo CPR, pH value in blood gas analysis and the presence of respiratory system diseases as the cause of arrest are important parameters in determining the probability of ROSC.

Keywords

• Return of Spontaneous Circulation (ROSC)
• Cardiopulmonary Resuscitation (CPR)
• Emergency Medicine

References

1. 1. Lick CJ, Aufderheide TP, Niskanen RA, et al. Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest. Critical care medicine. 2011;39(1):26-33. doi:10.1097/CCM.0b013e3181fa7ce4
2. 2. Nolan JP. Cardiac arrest and cardiopulmonary resuscitation. Seminars in Neurology. 2017;37(1):5-12. doi:10.1055/s-0036-15978327
3. 3. Baldi E, Caputo ML, Savastano S, et al. An Utstein-based model score to predict survival to hospital admission: The UB-ROSC score. International Journal of Cardiology. 2020;308:84-89. doi:10.1016/j.ijcard.2020.01.032
4. 4. Sedig K, Seaton MB, Drennan IR, Cheskes S, Dainty KN. “Drones are a great idea! What is an AED?” novel insights from a qualitative study on public perception of using drones to deliver automatic external defibrillators. Resuscitation Plus. 2020;4(August 2020):100033. doi:10.1016/j.resplu.2020.100033
5. 5. Olasveengen TM, Mancini ME, Perkins GD, et al. Adult Basic Life Support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2020;156:A35-A79. doi:10.1016/j.resuscitation.2020.09.010
6. 6. Cakmak S, Sogut O, Albayrak L, Yildiz A. Serum Copeptin Levels Predict the Return of Spontaneous Circulation and the Short-Term Prognosis of Patients with Out-of-Hospital Cardiac Arrest: A Randomized Control Study. Prehospital and Disaster Medicine. 2020;35(2):120-127. doi:10.1017/S1049023X2000014X
7. 7. Hajzargarbashi E, Omidi E, Esmailian M. Correlation of Patients’ Baseline Characteristics with Success Rate of Cardiopulmonary Resuscitation; a Cross-Sectional Study. Advanced Journal of Emergency Medicine. 2018;3(1):1-5. doi:10.22114/AJEM.v0i0.115
8. 8. Herlitz J, Engdahl J, Svensson L, Young M, Angquist KA, Holmberg S. Changes in demographic factors and mortality after out-of-hospital cardiac arrest in Sweden. Coronary artery disease. 2005;16(1):51-57. doi:10.1097/00019501-200502000-00010

9. 9. Winther-Jensen M, Kjaergaard J, Wanscher M, et al. No difference in mortality between men and women after out-of-hospital cardiac arrest. Resuscitation. 2015;96:78-84. doi:10.1016/J.RESUSCITATION.2015.06.030
10. 10. Corral Torres E, Hernández-Tejedor A, Suárez Bustamante R, de Elías Hernández R, Casado Flórez I, San Juan Linares A. Prognostic value of venous blood analysis at the start of CPR in non-traumatic out-of-hospital cardiac arrest: association with ROSC and the neurological outcome. Critical care (London, England). 2020;24(1):60. doi:10.1186/s13054-020-2762-5
11. 11. Kim YJ, Lee YJ, Ryoo SM, et al. Role of blood gas analysis during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients. Medicine. 2016;95(25):e3960. doi:10.1097/MD.0000000000003960
12. 12. Çalbay A, Çakır Z, Bayramoğlu A. Prognostic value of blood gas parameters and end-tidal carbon dioxide values in out-of-hospital cardiopulmonary arrest patients. Turkish journal of medical sciences. 2019;49(5):1298-1302. doi:10.3906/sag-1812-156
13. 13. Orban JC, Truc M, Kerever S, et al. Comparison of presumed cardiac and respiratory causes of out-of-hospital cardiac arrest. Resuscitation. 2018;129:24-28. doi:10.1016/j.resuscitation.2018.05.033