Abstract
BACKGROUND: The 2015 as well as the 2020 cardiopulmonary resuscitation guidelines have stressed that high-quality cardiopulmonary resuscitation increases the survival rates of patients suffering from nonshockable cardiac arrest. However, whether the management of adult patients with out-of-hospital cardiac arrest (OHCA), performed in accordance with the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) 2015, is associated with favorable neurological outcomes remains unknown. The present study aimed to study the relationship between the implementation of the CoSTR 2015 clinical recommendations and outcomes in adult patients with OHCA, using data from the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of OHCA. METHODS: In this study, 73 874 adults from the All-Japan Utstein Registry diagnosed with nonshockable OHCA that had been witnessed by bystanders or emergency medical service responders between 2011 and 2020 were included. The study outcomes were compared between 2012 and 2014 of the CoSTR 2010 era (2010 group) and 2017 and 2019 of the CoSTR 2015 era (2015 group). RESULTS: The adjusted odds ratio for the 30-day neurologically intact survival in the 2015 bystander-witnessed group compared with the 2010 group was 1.175 (95% CI, 1.014-1.362; P=0.032). Similar results were observed in the emergency medical service responder-witnessed group. CONCLUSIONS: The cardiopulmonary resuscitation maneuver updates recommended by CoSTR 2015 for nonshockable OHCA were associated with higher survival rates without neurological complications compared with those recommended by CoSTR 2010 in Japan. REGISTRATION: URL: http://www.umin.ac.jp/ctr/. Unique identifier: 000009918.