Predictive Factors for Failure of At-scene Cardiopulmonary Resuscitation in Adults with Non-Traumatic Out-of-Hospital Cardiac Arrest

OBJECTIVE: To identify the predictive factors of at-scene cardiopulmonary resuscitation (CPR) failure in out-of-hospital cardiac arrest (OHCA) patients.METHODS: A retrospective single centre, cross-sectional study methodology was employed, which collected from emergency medical services patient care reports of non-traumatic OHCA patients over 18 years old who underwent CPR for at least 20 minutes from 1 January 2017 to 31 December 2024. Univariate and multivariate analyses were employed, along with multiple logistic regression analysis to identify the predictive factors of at-scene CPR failure. Also the odds ratio (OR) and 95% confidence interval were reported.RESULTS: During the study period, 455 OHCA patients met the inclusion criteria. Statistically significant predictive factors for CPR failure (after at least 20 minutes of CPR conducted at-scene) included: ACLS in OHCA patients (p-value < 0.05); asystole as initial arrest rhythms (adjusted OR = 4.68, 95%CI: 2.48-8.86, p-value < 0.001); unwitnessed arrest (adjusted OR = 3.51, 95%CI: 2.14-5.76, p-value < 0.001); unresponsive pupils (adjusted OR = 4.22, 95%CI: 1.95-9.10, p-value < 0.001); no prehospital advanced airway management (adjusted OR = 7.34, 95%CI: 2.47-21.82, p-value < 0.001); and no prehospital drug administration during CPR – including no amiodarone (adjusted OR = 2.41, 95%CI: 1.15-5.04, p-value = 0.020), and no atropine (adjusted OR = 9.22, 95%CI: 2.22-38.25, p-value = 0.002).CONCLUSION: The study found 6 predictive factors for identifying failure after CPR for at least 20 minutes at the scene: asystole as the initial arrest rhythm, unwitnessed arrest, unresponsive pupils, no prehospital advanced airway management, and no prehospital administration of amiodarone and atropine during CPR. CPR team leaders may incorporate these factors when deciding when to terminate resuscitation at the scene.