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Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest

Rosell Ortiz F, García del Águila J, Fernåndez del Valle P, Mellado-Vergel FJ, Vergara-Pérez S, Ruiz-Montero MR, Martínez-Lara M, Gómez-Jiménez FJ, Gonzålez-Lobato I, García-Escudero G, Ruiz-Bailén M, Caballero García F, Caballero-García A, Vivar-Díaz I, Olavarría-Govantes L

Empresa PĂșblica de Emergencias Sanitarias de AndalucĂ­a, AlmerĂ­a, Spain. Unidad de InvestigaciĂłn, Hospital Virgen del RocĂ­o, Sevilla, Spain. Servicio de Urgencias, Hospital el Toyo, AlmerĂ­a, Spain. Facultad de Medicina, Universidad de Granada, Spain. Unidad de Cuidados Intensivos, Hospital de Linares, JaĂ©n, Spain.

Objective. To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport.
Methods. Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non–heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance
CPR, survival, and neurologic outcome.
Results. Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91–10.76); P<.001)], witnessed
OHCA (OR, 1.62; 95% CI, 1.16–2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38–4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07–2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17–2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58–4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24–2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome.
Conclusions. Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance
CPR, a strategy that can be considered futile.

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