Conversion to shockable rhythms during resuscitation and survival for out-of hospital cardiac arrest

Autor: Benjamin Sieu-Hon Leong, Kentaro Kajino, Julina Md Noor, Nurun Nisa de Souza, Win Wah, Marcus Eng Hock Ong, Ling Tiah, Pairoj Khruekarnchana, Andrew Fu Wah Ho, Khin Lay Wai, Michael Yih Chong Chia, Pin Pin Pek, Omer Alsakaf, Lai Peng Tham
Rok vydání: 2017
Předmět:
Male
Emergency Medical Services
medicine.medical_specialty
Resuscitation
Asia
medicine.medical_treatment
030204 cardiovascular system & hematology
Return of spontaneous circulation
Targeted temperature management
Statistics
Nonparametric
03 medical and health sciences
0302 clinical medicine
Outcome Assessment
Health Care
Humans
Medicine
Registries
Cardiopulmonary resuscitation
Intensive care medicine
Aged
Retrospective Studies
Aged
80 and over
Chi-Square Distribution
business.industry
Basic life support
030208 emergency & critical care medicine
General Medicine
Odds ratio
Middle Aged
Prognosis
medicine.disease
Survival Analysis
Cardiopulmonary Resuscitation
Logistic Models
Pulseless electrical activity
Emergency medicine
Ventricular fibrillation
Emergency Medicine
Female
business
Out-of-Hospital Cardiac Arrest
Zdroj: The American Journal of Emergency Medicine. 35:206-213
ISSN: 0735-6757
DOI: 10.1016/j.ajem.2016.10.042
Popis: Background In 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. Methodology This 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. Results 40,160 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. Conclusion Initial 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.
Databáze: OpenAIRE
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