A new multicenter study from South Korea has brought to light significant insights on the optimal duration of on-scene cardiopulmonary resuscitation (CPR) for patients experiencing out-of-hospital cardiac arrest (OHCA). The research indicates adjusting CPR times based on the transport time interval (TTI) could markedly improve survival rates.
The study, involving 65 hospitals and recorded data from October 2015 to December 2021, assessed how long EMS should perform CPR before transporting patients to hospitals. Traditionally, emergency medical services grapple with deciding between timely transfers to medical facilities and performing extended CPR on-site to improve survival chances.
With OHCA survival rates hovering around 10% globally, re-evaluations are necessary. The findings suggest the relationship between on-scene CPR duration and patient outcomes varies significantly based on TTI. Patients with shorter transport times, defined as less than 10 minutes, benefitted more from immediate transport after less than five minutes of CPR. Conversely, those facing longer transport times achieved favorable outcomes with prolonged CPR durations approaching the 5-minute mark.
"Adjusted on-scene CPR duration based on expected transport duration may be beneficial for favorable clinical outcomes in patients with OHCA," the authors of the study stated. This finding could reshape protocols by creating guidelines predicated on transport distance and anticipated traffic conditions.
The influence of TTI on patient outcomes indicates notable discrepancies between expedited transport and prolonged CPR. Analysis from the data of 6,345 patients showed only 7.4% of those transported immediately after short on-scene CPR survived with favorable outcomes, whereas 9.8% of patients benefitted from 5 minutes of on-scene CPR before transport.
Prior studies around the world have provided mixed results on whether expedited transport is more effective than extended on-scene CPR. Specific challenges within different emergency response systems and geographical variances have impacted these findings. South Korea's unique regulations prevent emergency medical technicians from deciding to halt resuscitation efforts and require patients to be transported regardless of initial conditions.
Particularly noteworthy is the study's conclusion: The optimal duration of on-scene CPR should be variable, dependent on conditions surrounding transport. "This study showed the optimal duration of on-scene CPR varies according to transport duration," noted the authors. They highlighted the feasibility of estimating required times for transport using current navigational technologies.
The research advocates for amendments to EMS guidelines reflecting findings about CPR durations and TTI, emphasizing benefits for clinical outcomes tied to more advanced predictive models involving transport predictions using real-time data.
Given the back-and-forth debates within the medical community about the most effective approach for handling OHCA cases, this study shines light on possible actionable strategies. Future research is necessary to refine these protocols and sum up the broader impacts on patient outcomes.