Age-specific differences in prognostic significance of rhythm conversion from initial non-shockable to shockable rhythm and subsequent shock delivery in out-of-hospital cardiac arrest

Funada, Akira; Goto, Yoshikazu; Tada, Hayato; Teramoto, Ryota; Shimojima, Masaya; Hayashi, Kenshi; Yamagishi, Masakazu

doi:10.1016/j.resuscitation.2016.09.013

Cited by 19 publications

(9 citation statements)

References 19 publications

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“…To our knowledge, only two studies have thus far analyzed data on shockable rhythm conversion and outcomes stratified by rhythm conversion time. Goto et al studied 569,937 OHCA patients enrolled in a Japanese national registry between 2005 and 2010 [12], and Funada et al studied 430,443 OHCA patients enrolled in the same registry between 2011 and 2014 [11]. Both studies involved only Japanese patients, categorized rhythm conversion times into 10-min intervals, assessed outcomes at one-month post-OHCA and did not stratify analyses by initial arrest rhythm (which has previously been shown to interact with shockable rhythm conversion for its associations with OHCA outcomes) [5,17].…”

Section: Discussionmentioning

confidence: 99%

“…Both studies involved only Japanese patients, categorized rhythm conversion times into 10-min intervals, assessed outcomes at one-month post-OHCA and did not stratify analyses by initial arrest rhythm (which has previously been shown to interact with shockable rhythm conversion for its associations with OHCA outcomes) [5,17]. ese researchers concluded that the first 20 min of CPR could be a threshold beyond which shockable rhythm conversion may no longer be associated with better outcomes in OHCA patients with initial nonshockable rhythms [11,12]. In contrast to these studies, the present study provides a more thorough delineation of the prognostic significance of shockable rhythm conversion stratified by initial heart rhythm, across the continuous spectrum of rhythm conversion time, and multiple OHCA outcomes that were assessed from at the field till hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

“…In a subgroup analysis, we found that the association between shockable rhythm conversion and 1-month favorable functional outcomes in patients with initial nonshockable rhythms tended to be weaker when rhythm conversion occurred late compared to early. In that analysis, however, only data from 2 studies, both conducted in Japan, were included [11,12]. Findings were not stratified by initial heart rhythm, and the full spectrum of OHCA outcomes was not examined.…”

Section: Introductionmentioning

confidence: 99%

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Conversion from Nonshockable to Shockable Rhythms and Out-of-Hospital Cardiac Arrest Outcomes by Initial Heart Rhythm and Rhythm Conversion Time

Zhang

Luo

Yang

et al. 2020

Cardiology Research and Practice

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Background. e conversion from a nonshockable rhythm (asystole or pulseless electrical activity (PEA)) to a shockable rhythm (pulseless ventricular tachycardia or ventricular fibrillation) may be associated with better out-of-hospital cardiac arrest (OHCA) outcomes. ere are insufficient data on the prognostic significance of such conversions by initial heart rhythm and different rhythm conversion time. Methods. Among 24,849 adult OHCA patients of presumed cardiac etiology with initial asystole or PEA in the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registry (version 3, 2011-2015), we examined the association of shockable rhythm conversion with prehospital return of spontaneous circulation (ROSC), survival, and favorable functional outcome (modified Rankin Scale score ≤3) at hospital discharge by initial rhythm and rhythm conversion time (time from cardiopulmonary resuscitation (CPR) initiation by emergency medical providers to first shock delivery), using logistic regression adjusting for key clinical characteristics. Results. Of 16,516 patients with initial asystole and 8,333 patients with initial PEA, 16% and 20% underwent shockable rhythm conversions; the median rhythm conversion time was 12.0 (IQR: 6.7-18.7) and 13.2 (IQR: 7.0-20.5) min, respectively. No difference was found in odds of prehospital ROSC across rhythm conversion time, regardless of initial heart rhythm. Shockable rhythm conversion was associated with survival and favorable functional outcome at hospital discharge only when occurred during the first 15 min of CPR, for those with initial asystole, or the first 10 min of CPR, for those with initial PEA. e associations between shockable rhythm conversion and outcomes were stronger among those with initial asystole compared with those with initial PEA. Conclusions. e conversion from a nonshockable rhythm to a shockable rhythm was associated with better outcomes only when occurred early in initial nonshockable rhythm OHCA, and it has greater prognostic significance when the initial rhythm was asystole.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Conversion from Nonshockable to Shockable Rhythms and Out-of-Hospital Cardiac Arrest Outcomes by Initial Heart Rhythm and Rhythm Conversion Time

Zhang

Luo

Yang

et al. 2020

Cardiology Research and Practice

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“…The authors further excluded variables in the adjusted analysis with documented baseline differences between TTM treated patients and untreated patients, including gender and defibrillation at any time during resuscitation. Both have been shown to influence outcome after OHCA (10,11). A recent review of utilisation of TTM for patients with non-shockable rhythm conclude that further studies are needed to identify which patients may benefit for the treatment (12).…”

Section: Ttm For Patients Resuscitated From a Nonshockable Rhythmmentioning

confidence: 99%

Does temperature management improve outcome in patients resuscitated from a non-shockable rhythm?

2017

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“…The American Heart Association and the European Resuscitation Council guidelines cautioned that prognostication for outcomes after cardiac arrest should be used cautiously if the 95% CI of a diagnostic test is between 90% and 95% due to its imprecision [3,4]. Moreover, our previous studies showed that both age and duration of CPR are critical components for predicting favorable outcomes after OHCA [5][6][7][8][9]. Therefore, to improve utilization of hospital healthcare resources, to reduce both attendant hazards for EMS personnel and unnecessary transportation of patients with OHCA, and to increase the availability of transport for other patients, a novel TOR rule with high specificity that incorporates age and the time the rule is applied is required.…”

Section: Introductionmentioning

confidence: 99%

Field termination-of-resuscitation rule for refractory out-of-hospital cardiac arrests in Japan

Goto

Funada

Maeda

et al. 2019

Journal of Cardiology

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Background: Guidelines for cardiopulmonary resuscitation (CPR) recommend using the universal termination-of-resuscitation (TOR) rule to identify out-of-hospital cardiac arrest (OHCA) patients eligible for field termination of resuscitation, thus avoiding medically futile transportation to the hospital. However, in Japan, emergency medical services (EMS) personnel are forbidden from terminating CPR in the field and transport almost all patients with OHCA to hospitals. We aimed to develop and validate a novel TOR rule to identify patients eligible for field termination of CPR. Methods: We analyzed 540,478 patients with OHCA from 2011 to 2015 using a Japanese registry. Main outcome measures were specificity and positive predictive value (PPV) of the newly developed TOR rule in predicting 1-month mortality after OHCA. Results: Recursive partitioning analysis in the development group (n = 434,208) showed that EMS personnel could consider TOR if patients with OHCA met all of the following five criteria: (1) initial asystole, (2) arrest unwitnessed by a bystander, (3) age 81 years, (4) no bystander-administered CPR or automated external defibrillator use before EMS arrival, and (5) no return of spontaneous circulation after EMS-initiated CPR for 14 min. For patients meeting these criteria, specificity and PPV for predicting 1-month mortality were 99.2% [95% confidence interval (CI), 99.0-99.3%] and 99.7% (95% CI, 99.6-99.7%), respectively, for the development group and were 99.5% (95% CI, 99.3-99.7%) and 99.8% (95% CI, 99.7-99.9%), respectively, for the validation group. Implementation of this novel rule would reduce patient transports to hospitals by 10.6% in the development group and 10.4% in the validation group. Conclusions: Having both high specificity and PPV of >99% for predicting 1-month mortality, our developed TOR rule may be applied in the field for Japanese patients with OHCA who meet all five criteria. Prospective validation studies and establishment of prehospital EMS protocol are required before implementing this rule.

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Age-specific differences in prognostic significance of rhythm conversion from initial non-shockable to shockable rhythm and subsequent shock delivery in out-of-hospital cardiac arrest

Cited by 19 publications

References 19 publications

Conversion from Nonshockable to Shockable Rhythms and Out-of-Hospital Cardiac Arrest Outcomes by Initial Heart Rhythm and Rhythm Conversion Time

Conversion from Nonshockable to Shockable Rhythms and Out-of-Hospital Cardiac Arrest Outcomes by Initial Heart Rhythm and Rhythm Conversion Time

Does temperature management improve outcome in patients resuscitated from a non-shockable rhythm?

Field termination-of-resuscitation rule for refractory out-of-hospital cardiac arrests in Japan

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