Conversion to shockable rhythms during resuscitation and survival for out-of hospital cardiac arrest |
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Authors: | Win Wah Khin Lay Wai Pin Pin Pek Andrew Fu Wah Ho Omer Alsakaf Michael Yih Chong Chia Julina Md Noor Kentaro Kajino Nurun Nisa Amatullah De Souza Marcus Eng Hock Ong |
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Institution: | 1. Saw Swee Hock School of Public Health, National University of Singapore, Singapore;2. Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore;3. Department of Emergency Medicine, Singapore General Hospital, Singapore;4. Emergency Medicine Residency Program, SingHealth Services, Singapore;5. Dubai Corporation for Ambulance Services, Dubai, United Arab Emirates;6. Emergency Department, Tan Tock Seng Hospital, Singapore;7. Department of Emergency and Trauma, Hospital Sungai Buloh, Selangor, Malaysia;8. Critical Care Medical Center, Osaka National Hospital, Osaka, Japan;9. Epidemiology Department, Singapore Clinical Research Institute Pte Ltd, Singapore;10. Department of Emergency Medicine, Singapore General Hospital, Singapore;11. Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore |
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Abstract: | BackgroundIn out of hospital cardiac arrest (OHCA), the prognostic influence of conversion to shockable rhythms during resuscitation for initially non-shockable rhythms remains unknown. This study aimed to assess the relationship between initial and subsequent shockable rhythm and post-arrest survival and neurological outcomes after OHCA.MethodologyThis was a retrospective analysis of all OHCA cases collected from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry in 7 countries in Asia between 2009 and 2012. We included OHCA cases of presumed cardiac etiology, aged 18-years and above and resuscitation attempted by EMS. We performed multivariate logistic regression analyses to assess the relationship between initial and subsequent shockable rhythm and survival and neurological outcomes. 2-stage seemingly unrelated bivariate probit models were developed to jointly model the survival and neurological outcomes. We adjusted for the clustering effects of country variance in all models.Results40,160 OHCA cases met the inclusion criteria. There were 5356 OHCA cases (13.3%) with initial shockable rhythm and 33,974 (84.7%) with initial non-shockable rhythm. After adjustment of baseline and prehospital characteristics, OHCA with initial shockable rhythm (odds ratio/OR = 6.10, 95% confidence interval/CI = 5.06–7.34) and subsequent conversion to shockable rhythm (OR = 2.00,95%CI = 1.10–3.65) independently predicted better survival-to-hospital-discharge outcomes. Subsequent shockable rhythm conversion significantly improved survival-to-admission, discharge and post-arrest overall and cerebral performance outcomes in the multivariate logistic regression and 2-stage analyses.ConclusionInitial shockable rhythm was the strongest predictor for survival. However, conversion to subsequent shockable rhythm significantly improved post-arrest survival and neurological outcomes. This study suggests the importance of early resuscitation efforts even for initially non-shockable rhythms which has prognostic implications and selection of subsequent post-resuscitation therapy. |
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Keywords: | OHCA out-of hospital cardiac arrest PAROS Pan-Asian resuscitation outcomes study EMS emergency medical services VF ventricular fibrillation PVT pulseless ventricular tachycardia PEA pulseless electrical activity VT ventricular tachycardia CPR cardio-pulmonary resuscitation TTM targeted temperature management PCI percutaneous coronary intervention ECMO extracorporeal membrane oxygenation AED automatic external defibrillators BLS basic life support ED emergency department ROSC return of spontaneous circulation OPC overall performance category CPC cerebral performance category SUBPR seemingly unrelated bivariate probit regression OR odds ratio CI confidence interval |
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