Outcomes of treatment in patients with refractory circulatory arrest admitted to St. Petersburg hospitals: a two-year retrospective analysis

Introduction. Nowadays the question of expediency of transporting patients with an out-of-hospital refractory circulatory arrest to a medical institution arises hugely due to the emergence of technical capabilities providing long-term automatic indirect cardiac massage. This is a worldwide problem. Although there are protocols in many countries which determine the need for further patient evacuation to a hospital or the validity of termination of resuscitation measures on the spot due to their ineffectiveness. Aim of the study. The main goal is to evaluate the treatment results of working-age patients admitted to St. Petersburg hospitals with an out-of-hospital cardiac arrest, and to investigate spectrum of factors influencing the outcomes of resuscitation measures. Materials and methods. This is a retrospective multicenter study. All in all, 349 inpatient treatment results were analyzed in adult working-age patients admitted to four multidisciplinary hospitals in St. Petersburg during 2022–2024 period. Patients were divided into 2 groups. Group 1 —  patients who suffered circulatory arrest, with heart rhythm restored during pre-hospital stage (97 people, 80.4% men, average age 45±1.3 years). Group 2 —  patients admitted in a state of clinical death with an ongoing resuscitation using a mechanical CPR device (252 people, 77.9% men, average age 49.7±0.7 years). Obtained data were statistically processed with the use of four-field tables method and the χ2 criterion. Results. There was a significant difference in hospital mortality between the groups: 78.4% in group 1 versus 98.8% in group 2 (χ2 45.78, p<0.001). A detailed study of surviving patients records in group 2 showed, that in all cases witnesses promptly initiated first aid in the CPR form; Two out of three survivors were rescued with the use of ECMO-CPR complex on a hospital bed. Conclusion. There is a growing need for a domestic protocol regarding the termination of resuscitation on the spot. Its› creation is dictated by the extreme mortality rate of patients hospitalized with refractory cardiac arrest. Survival chain implementation with the use of the entire range of modern technologies is absolutely necessary in order to achieve better treatment results.><0.001). A detailed study of surviving patients records in group 2 showed, that in all cases witnesses promptly initiated first aid in the CPR form; Two out of three survivors were rescued with the use of ECMO-CPR complex on a hospital bed. Conclusion. There is a growing need for a domestic protocol regarding the termination of resuscitation on the spot. Its› creation is dictated by the extreme mortality rate of patients hospitalized with refractory cardiac arrest. Survival chain implementation with the use of the entire range of modern technologies is absolutely necessary in order to achieve better treatment results.

1. Leong S. H. Mechanical CPR // Singapore Med. J. 2011. Vol. 52, No. 8. P. 592–595.

2. Teplov V. M., Shah B. N., Loginov I. V., Senchik K. Y. Evolution of devices for external cardiocompression. Emergency medical care, 2012, Vol. 13, No. 4, рр. 32–36 (In Russ.).

3. Teplov V. M., Prasol D. M., Kolomoytsev V. V., Arkhangelsky N. D., Bagnenko S.F. The center for the treatment of sudden cardiac death: the results of five years of work. Messenger of Anesthesiology and Resuscitation, 2023, Vol. 20, No. 1, рр. 17–23 (In Russ.).

4. Grunau B., Kime N., Leroux B., Rea T., Van Belle G., Menegazzi J. J., Kudenchuk P. J., Vaillancourt C., Morrison L. J., Elmer J., Zive D. M., Le N. M., Austin M., Richmond N. J., Herren H., Christenson J. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest // JAMA. 2020. Vol. 324, No. 11. P. 1058–1067.

5. Okubo M., Komukai S., Izawa J., Chung S., Drennan I.R., Grunau B.E., Lupton J.R., Ramgopal S., Rea T.D., Callaway C.W. Survival After Intra-Arrest Transport vs On-Scene Cardiopulmonary Resuscitation in Children // JAMA Netw Open. 2024. Vol. 7, No. 5. Article e2411641.

6. Khan S.U., Lone A.N., Talluri S., Khan M.Z., Khan M.U., Kaluski E. Efficacy and safety of mechanical versus manual compression in cardiac arrest — A Bayesian network meta-analysis // Resuscitation. 2018. Vol. 130. P. 182–188.

7. Wang P.L., Brooks S.C. Mechanical versus manual chest compressions for cardiac arrest // Cochrane Database Syst. Rev. 2018. Vol. 8, No. 8. Article CD007260.

8. Bailey E.D., Wydro G.C., Cone D.C. Termination of resuscitation in the prehospital setting for adult patients suffering nontraumatic cardiac arrest. National Association of EMS Physicians Standards and Clinical Practice Committee // Prehosp. Emerg. Care. 2000. Vol. 4, No. 2. P. 190–195.

9. Millin M.G., Khandker S.R., Malki A. Termination of resuscitation of nontraumatic cardiopulmonary arrest: resource document for the National Association of EMS Physicians position statement // Prehosp. Emerg. Care. 2011. Vol. 15, No. 4. P. 547–554.

10. Morrison L. J. Prehospital termination of resuscitation rule // Curr. Opin. Crit. Care. 2019. Vol. 25, No. 3. P. 199–203.