Abstract Introduction It is unknown how long resuscitation in out-of-hospital cardiac arrest (OHCA) can continue without risking severe cerebral damage. Death from cardiac arrest often occurs within 30 days, with anoxic brain injury (ABI) as a leading cause. Currently, no single factor justifies terminating resuscitation. However, rescuers may at times rely on time elapsed as justification for termination, potentially overemphasizing its role. With advancements in response times, quality measures, and chain-of-survival strategies, the impact of cardiac arrest duration on survivors remains uncertain. Purpose To assess whether time to return of spontaneous circulation (ROSC) in OHCA survivors affects functional outcomes, using return to work, nursing home care, and ABI as proxies. We hypothesize that time to ROSC has no significant impact on long-term outcomes. However, if a difference exists, we expect shorter durations to be favorable. Methods This nationwide registry-based follow-up study of 3,381 adult 30-day OHCA survivors from 2016 to 2023, includes only patients with single-occurrence, witnessed cardiac arrest and no prior ABI or nursing home care. The incoming emergency call serves as a baseline for time. Patients are stratified in groups by fixed cut-off intervals to ROSC (a) 0-10 min n=795, (b) 11-20 min n=1,400, (c) 21-30 min n=624, and (d) 30 min n=562. Data are linked by civil registration numbers to information from death records, discharge diagnoses, and social registries, with follow-up ending January 26, 2024. Statistical analyses are run in R, using Aalen-Johansen competing risk model to estimate the likelihood of regaining employment and univariate descriptive test analysis on nursing home care and ABI. Results Overall, 76% of survivors are male, with a median age of 65 years and a median ROSC within 16 minutes. Time to ROSC did not affect 1-year survival (92.7%, p=0.329). Both bystander cardiopulmonary resuscitation and layperson defibrillation show an inverse relationship with duration (p0.001). ABI varies across strata (a) 8 (1.0%), (b) 53 (3.8%), (c) 35 (5.6%), and (d) 24 (4.3%) p0.001). Along with diversity in nursing home care (a) 26 (3.3%), (b) 36 (2.6%), (c) 6 (1.0%), (d) 13 (2.3%), p = 0.04), though underpowered (67%). However, neither outcome demonstrates a consistent time-related trend Picture 1. Lastly, for employed patients (a) 159, (b) 267, (c) 146, (d) 112), no meaningful variation in work recovery was observed. After five years, a similar portion of victims has returned to work (a) 59%, (b) 63%, (c) 62%, and (d) 59% Picture 2). Conclusion Among 30-day OHCA survivors, time from emergency call to ROSC is not associated with the risk of anoxic brain injury, though ROSC within 10 minutes is ideal. In employed patients, there is no association with time from emergency call to ROSC and employment recovery. Factors beyond resuscitation time should guide continued treatment in OHCA.1) Functional outcomes 2) Employment Recovery
Oxwall et al. (Sat,) studied this question.