We sought to determine predictors of good neurological outcome (defined as a Pittsburgh Cerebral Performance Category (CPC) score of 1) in asystolic cardiac arrest in our county.

This study examines 12 months of consecutive EMS patient data to identify predictors of good outcome after adult out of hospital cardiac arrest (OHCA), including return of spontaneous circulation (ROSC), survival to hospital admission (HA), survival to hospital discharge (HD), and survival with CPC score of 1. Four logistic regression models were performed using JMP 16.0 Pro for Mac, each with the following seven predictors: age, sex, epinephrine administration, time from collapse to CPR, hypothermia protocol,  automatic external defibrillator (AED) placement, and whether the arrest was witnessed.  

Median age of the cohort (N=948) was 66 years (IQR 53-77). Arrest was witnessed in 40%; an AED was used in 20%, and defibrillation occurred in 3%. 16% had ROSC (more than 5x the national average), 14% HA, 4% HD, and 2% had good neurologic outcome. The median time to first CPR was 8 minutes, ( IQR 1-19). 

Predictors of ROSC included receiving hypothermia care (OR 2.34, 95% CI 1.42-3.85, P=0.0008), and female gender (OR 1.96, 95% CI 1.2-3.2, P=0.0072). Predictors of HA included shorter time to CPR (P<0.0001) and receiving hypothermia care (OR 1.73, 95% CI 1.05-2.85, P=0.0013). 

Predictors of good neurologic outcome (CPC =1) included shorter time to CPR (OR 0.76, 95% 0.50-0.93, P=0.0005). In other words, every additional one minute from time of collapse to CPR resulted in 24% decreased odds of good neurologic outcome.

Adherence to timely on scene arrival and management results in improved neurological outcome after OHCA. The results reinforce the teaching that every minute to prompt CPR counts for optimal brain health.