Out-of-hospital cardiac arrest (OHCA) is among the leading causes of death and is a vital public health issue globally. OHCA is a worldwide problem affecting about 55 of every 100,000 people (Rhee et al., 2020). Lai et al. (2018) defined cardiac arrest as the “sudden cessation of heartbeat and the abrupt loss of cardiac mechanical activity in a person who may or may not have been diagnosed with heart disease, confirmed by the absence of a detectable pulse and unresponsiveness of apnea” (p. or para. #). Reynolds et al. (2016) found that over 356,000 people experience a sudden OHCA annually in the united states. Survival is related to different OHCA factors, including CPR duration, age, gender, and whether one is a medical or trauma patient.
The implementation of CPR guidelines appears to have improved patients’ survival rates after an OHCA. According to Larribau et al. (2018), CPR guidelines are updated every 5 years, with the gradual improvement in treatment leading to the doubling of survival rates for shockable and non-shockable OHCAs over the past 3 decades. Prompt intervention and CPR are critical for survival and minimizing neurological damage in patients experiencing OHCAs (Mathiesen, et al., 2018). Thus, CPR is vital for increased chances of survival.
Research about the optimal CPR duration for patients with OHCAs has presented different results concerning survival. Nehme et al. (2016) stated that resuscitation guidelines recommend continuous CPR efforts to hospitals for OHCAs witnessed by EMS personnel. The study explored the impact of CPR duration on the survival of paramedic-observed OHCAs. The authors determined that the median CPR duration was 12 min overall but the duration was higher in nonsurvivors than in survivors (24 min versus 2 min; Nehme et al., 2016). Therefore, Nehme et al. concluded that resuscitation efforts exceeding 32 min resulted in a less than 1% survival rate for EMS-witnessed OHCAs. A similar study by Matsuyama et al. (2017) determined the median CPR duration was 25 min and concluded that the survival rate and the number of patients with desirable results were reduced with increasing CPR durations. However, the researchers determined that some OHCA patients could benefit from prolonged CPR of less than 30 min.
Other studies have also examined the link between promising results and the resuscitation period. For instance, Reynolds et al. (2016) explored the association between resuscitation duration and favorable outcomes after OHCAs. They found that for a CPR duration up to 37 min, 99% of patients achieved a return of spontaneous circulation (ROSC). The authors concluded that a shorter CPR duration is related to the higher likelihood of desirable outcomes at hospital discharge. However, patients with favorable health traits were more likely to survive prolonged CPR up to 47 min. Hara et al. (2015) indicated that OHCA results differed based on the period between initial CPR and first recorded rhythm. Thus, shortening the time to initial CPR is critical for improving OHCA outcomes.
Gender also significantly affects the survival rate. Rhee et al. (2020) determined that the survival rate in male patients was 13.7% higher than in females. Age affects survival rates significantly, and Rhee et al. indicated that the survival rate for patients aged 7–18 years is highest at 30.7% and declines with age. Huang et al. (2021) explored the impact of age on survival by observing two age groups, below and above 75 years, and found a significant difference between survival to hospital discharge by age (p = 0.006 and p < 0.001, respectively). Huang et al. explained that old age is a poor prognosticator of OHCA outcomes and indicated that the odds ratio for poor outcomes is 1.97 for individuals aged 60–80 years and 8.97 for those over 80 years.
Furthermore, the odds ratio for a 1-year survival rate following OHCA is 0.96 for every additional year. Consequently, Huang et al. (2021) postulated that different comorbidities of medical OHCA patients, such as hypertension, diabetes, liver disease, stroke, renal disease, and respiratory disease, affect the survival rate. Fukuda et al. (2016) determined that stroke-related OHCA patients have better chances of prehospital ROSC than OHCA patients with a presumed cardiac etiology but a reduced chance of 1-month survival or desirable results. The authors also affirmed that having a younger age and shockable initial documented rhythm were related to an improved survival rate and that men have a more favorable survival rate and better outcomes than women.
The discussion above has shown the effects of CPR duration, age, gender, and medical or trauma status on survival rates. The studies presented similar findings concerning age, medical status, and gender, but the results regarding the optimal number of minutes of CPR duration differed between studies. However, the investigations affirmed that shortening the time to initial CPR is critical for improving OHCA outcomes and that younger male individuals with no underlying issues have higher survival rates than their female counterparts. Finally, the available studies demonstrated mixed findings and the biggest challenge for a physician is deciding when to terminate CPR in OHCAs. No study has been performed in Industrial Jubail, Saudi Arabia, to determine the impact of CPR duration and the demographic factors on OHCA survival rates. Moreover, this study aimed to investigate and determine the influence of gender, age, CPR duration, and medical status on survival rates at a secondary hospital in Industrial Jubail.