Association between cardiac rhythm conversion and neurological outcome among cardiac arrest patients with initial shockable rhythm: a nationwide prospective study in Japan

Abstract

Aims Initial cardiac rhythm, particularly shockable rhythm, is a key factor in resuscitation for out-of-hospital cardiac arrest (OHCA) patients. The purpose of this study was to clarify the association between cardiac rhythm conversion and neurologic prognosis in OHCA patients with initial shockable rhythm at the scene. Methods and results The study included adult patients with OHCA due to medical causes with pre-hospital initial shockable rhythm and who were still in cardiac arrest at hospital arrival. Multiple logistic regression analysis was conducted to identify the adjusted odds ratios (AORs) and 95% confidence interval (CI) of cardiac arrest rhythm at hospital arrival for 1-month favourable neurologic status and 1-month survival, adjusted for potential confounders. Of 34 754 patients in the 2014–2017 JAAM-OHCA Registry, 1880 were included in the final study analysis. The percentages of 1-month favourable neurologic status for shockable rhythm, pulseless electrical activity (PEA), and asystole at hospital arrival were 17.4% (137/789), 3.6% (18/507), and 1.5% (9/584), respectively. The AORs for 1-month favourable neurologic status comparing to OHCA patients who maintained shockable rhythm at hospital arrival were PEA, 0.19 (95% CI, 0.11–0.32) and asystole, 0.08 (95% CI, 0.04–0.16), respectively. Conclusion Findings showed that the 1-month neurologic outcome in OHCA patients who converted to non-shockable rhythm at hospital arrival was very poor compared with patients who had sustained shockable rhythm. Also, patients with conversion to PEA had better neurologic prognosis than conversion to asystole.

Development and validation of early prediction for neurological outcome at 90 days after return of spontaneous circulation in out-of-hospital cardiac arrest

“…Potential variables included in the CRITICAL database that were measurable and available immediately after ROSC were included as candidate predictors, based on previous studies and expert opinion. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] We developed two prediction models using different sets of variables: model 1 included demographics, pre-hospitalisation and in-hospital information at the time of ROSC, except for laboratory data, and model 2 included all variables that contained the laboratory data available within 3 h of ROSC. The best level of consciousness to ICU admission was determined using the Glasgow Coma Scale motor score.…”

Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis

“…In general OHCA, initial cardiac rhythm, especially defibrillation waveforms, is an important factor of OHCA and a good indicator of a favorable 1-month neurologic status. [22] A shockable initial rhythm affects the outcome regardless of the age of the patient. [23] In the present study, hypothermic OHCA had a shockable initial rhythm rate of 30.8% (483/1570).…”

Investigating the outcomes of cardiopulmonary resuscitation and factors affecting it: A cross‐sectional study at Dr. Moaven Hospital, Sahneh City from 2014 to 2021

“…37.5% of VT patients who received a defibrillator returned to their cardiac rhythm and had a successful resuscitation, while 27.6% of Vf patients who received a defibrillator had a successful resuscitation. According to Andersen and Kanori, 21,34 patients with shockable rhythms are two to three times more likely to return and live than patients without shockable rhythms.…”