The Impact of CPR Duration on Neurological Outcomes in IHCA Patients Classified by NEWS

Sunday, February 23, 2025

10:45am – 11:45am Eastern Time

Location: Connections Central Theater 1

Jumpei Tsukuda, MD, MPH (he/him/his)

Disclosure(s): No relevant financial relationship(s) to disclose.
TN

Takaki Naito, MD, PhD

Assistant professor
St.Marianna University

Disclosure information not submitted.
CS

Chinami Sakurai, MD

Assistant professor
St.Marianna University

Disclosure information not submitted.
Toru Yoshida, MD, Ph D

Disclosure information not submitted.
SF

Shigeki Fujitani, MD, PhD

Professor
St.Marianna University

Disclosure information not submitted.

Disclosure(s):

Jumpei Tsukuda, MD, MPH: No relevant financial relationship(s) to disclose.

Introduction: Many studies related to cardiac arrest focus on out-of-hospital cardiac arrest and only 4% are related to in-hospital cardiac arrest (IHCA).
To assess the impact of the duration of cardiopulmonary resuscitation (CPR) on the neurological outcomes of IHCA patients, we performed a prospective cohort study using the data derived from In-Hospital Emergency Registry in Japan (IHER-J).

Methods: IHCA patients were stratified into high-risk group or low-risk group using the National Early Warning Score (NEWS) which was calculated based on the final vital signs before cardiac arrest. High-risk group was defined as NEWS ≥7 and low-risk group as NEWS < 7. Neurological outcome was defined as favorable if the cerebral performance category (CPC) score was 1 or 2.

Results: A total of 1,617 adult patients aged 18 years and older who suffered from IHCA during the study period were included in the study. Median age of the patients was 75 [67-83] years. 1,025 (63%) were male and 771 (48%) were medical patients. 1,094 patients obtained return of spontaneous circulation (ROSC) and 288 had a CPC score of 1-2. The median time from initial chest compression to ROSC was 11 [5-20] minutes. The most frequently missing NEWS parameter was respiratory rate, which was absent in 714 (44%) of the NEWS measurements, followed by temperature, which was missing in 604 (37%). For low-risk group patients, the odds ratio of having a CPC score of 1-2 was 2.5 [95% CI 1.9-3.3], and the probability of achieving a favorable neurological outcome decreased from 6.5% after one minute of CPR to less than 1% after 20 minutes of CPR. In contrast, among high-risk patients, the probability dropped from 2.2% after one minute of CPR to less than 1% after 8.5 minutes of CPR.

Conclusions: This was the first report derived from IHER-J that assessed the time-dependent probability of patient outcomes for each minute of CPR duration categorized by NEWS. It may be possible to objectively predict the probability of favorable outcomes after ROSC based on the NEWS prior to cardiac arrest.