Progressing from initial non-shockable rhythms to a shockable rhythm is associated with improved outcome after out-of-hospital cardiac arrest

Olasveengen, Theresa M.; Samdal, Martin; Steen, Petter Andreas; Wik, Lars; Sunde, Kjetil

doi:10.1016/j.resuscitation.2008.09.003

Cited by 41 publications

(30 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(18) Three subsequent studies of OHCA however reported contrary findings, all noting improved survival of patients who converted to shockable rhythms after initially presenting with non-shockable rhythms. (19–21) More recently, an in-hospital cardiac arrest study reported findings similar to those reported by Hallstrom et al with higher survival in both PEA and asystole patients who never converted to shockable rhythms. (22)…”

Section: Introductionsupporting

confidence: 55%

Survival in out-of-hospital cardiac arrests with initial asystole or pulseless electrical activity and subsequent shockable rhythms

Thomas

Newgard

et al. 2013

Resuscitation

View full text Add to dashboard Cite

Background Non-shockable arrest rhythms (Pulseless Electrical Activity and Asystole) represent an increasing proportion of reported cases of out-of-hospital cardiac arrest (OHCA). The prognostic significance of conversion from non-shockable to shockable rhythms during the course of resuscitation remains unclear. Objective To evaluate whether out-of-hospital cardiac arrest survival with initially non-shockable arrest rhythms is improved with subsequent conversion to shockable rhythms. Methods Secondary analysis of data in Epistry – Cardiac Arrest, an epidemiologic registry maintained by the Resuscitation Outcomes Consortium (ROC). This analysis includes OHCA events from December 1, 2005 through May 31, 2007 contributed by six US and two Canadian sites. For all EMS-treated adult (18 and older) cardiac arrest patients who presented with non-shockable cardiac arrest, we compared survival to hospital discharge between patients who did develop a shockable rhythm and those who did not based on receipt of subsequent defibrillation. Missing data were handled using multiple imputation. Multivariable logistic regression was used to adjust for potentially confounding variables. Results A total of 6,556 EMS treated adult cardiac arrest cases presented in non-shockable rhythms. Survival to discharge in patients who converted to a shockable rhythm was 2.77% while survival in those who did not was 2.72% (p = 0.92). After adjusting for confounders, conversion to a shockable rhythm was not associated with improved survival (OR 0.88, 95% CI: 0.60–1.30). Conclusion For OHCA patients presenting in PEA/Asystole, survival to hospital discharge was not associated with conversion to a shockable rhythm during EMS resuscitation efforts.

show abstract

Section: Introductionsupporting

confidence: 55%

Survival in out-of-hospital cardiac arrests with initial asystole or pulseless electrical activity and subsequent shockable rhythms

Thomas

Newgard

et al. 2013

Resuscitation

View full text Add to dashboard Cite

show abstract

“…The most common sequence of events leading to SCA is the degeneration of ventricular tachycardia (VT) into ventricular fibrillation (VF), often followed by asystole or pulseless electric activity (PEA) (27). In the context of out-of-hospital SCA (OHSCA) cardiac arrest, asystole is a nonshockable rhythm associated with a very poor prognosis of survival to hospital discharge (21,22,37). In recent years the reported incidence of asystole as the first recorded rhythm during OHSCA has increased compared with the incidence of VF (14,41), which at least in part reflects faster degeneration of VF into asystole (26).…”

mentioning

confidence: 99%

β-Adrenergic stimulation and rapid pacing mutually promote heterogeneous electrical failure and ventricular fibrillation in the globally ischemic heart

Garg

Taylor

Warren

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

bayama J, Zaitsev A. ␤-Adrenergic stimulation and rapid pacing mutually promote heterogeneous electrical failure and ventricular fibrillation in the globally ischemic heart. Am J Physiol Heart Circ Physiol 308: H1155-H1170, 2015. First published February 20, 2015 doi:10.1152/ajpheart.00768.2014.-Global ischemia, catecholamine surge, and rapid heart rhythm (RHR) due to ventricular tachycardia or ventricular fibrillation (VF) are the three major factors of sudden cardiac arrest (SCA). Loss of excitability culminating in global electrical failure (asystole) is the major adverse outcome of SCA with increasing prevalence worldwide. The roles of catecholamines and RHR in the electrical failure during SCA remain unclear. We hypothesized that both ␤-adrenergic stimulation (␤AS) and RHR accelerate electrical failure in the globally ischemic heart. We performed optical mapping of the action potential (OAP) in the right ventricular (RV) and left (LV) ventricular epicardium of isolated rabbit hearts subjected to 30-min global ischemia. Hearts were paced at a cycle length of either 300 or 200 ms, and either in the presence or in the absence of ␤-agonist isoproterenol (30 nM). 2,3-Butanedione monoxime (20 mM) was used to reduce motion artifact. We found that RHR and ␤AS synergistically accelerated the decline of the OAP upstroke velocity and the progressive expansion of inexcitable regions. Under all conditions, inexcitability developed faster in the LV than in the RV. At the same time, both RHR and ␤AS shortened the time to VF (TVF) during ischemia. Moreover, the time at which 10% of the mapped LV area became inexcitable strongly correlated with TVF (R 2 ϭ 0 .72, P Ͻ 0.0001). We conclude that both ␤AS and RHR are major factors of electrical depression and failure in the globally ischemic heart and may contribute to adverse outcomes of SCA such as asystole and recurrent/persistent VF.

show abstract

“…[32][33][34] Since all our patients are in this favourable group, a good outcome was expected. However, it is remarkable that the patients score better for bodily pain and mental health than the general population.…”

Section: Discussionmentioning

confidence: 89%

Repeated magnetic resonance imaging and cerebral performance after cardiac arrest—A pilot study

et al. 2011

View full text Add to dashboard Cite

Progressing from initial non-shockable rhythms to a shockable rhythm is associated with improved outcome after out-of-hospital cardiac arrest

Cited by 41 publications

References 26 publications

Survival in out-of-hospital cardiac arrests with initial asystole or pulseless electrical activity and subsequent shockable rhythms

Survival in out-of-hospital cardiac arrests with initial asystole or pulseless electrical activity and subsequent shockable rhythms

β-Adrenergic stimulation and rapid pacing mutually promote heterogeneous electrical failure and ventricular fibrillation in the globally ischemic heart

Repeated magnetic resonance imaging and cerebral performance after cardiac arrest—A pilot study

Contact Info

Product

Resources

About