The prognostic significance of repeated prehospital shocks for out-of-hospital cardiac arrest survival
| Autor: | Alain Vadeboncoeur, Jean-Marc Chauny, Éric Notebaert, Yoan Lamarche, Martin Albert, Raoul Daoust, Sylvie Cossette, Alexis Cournoyer, Judy Morris, Francis Bernard, André Y. Denault, Martin Marquis, Yiorgos Alexandros Cavayas, François de Champlain, Dave Ross, L. Londei-Leduc, Catalina Sokoloff, Brian J. Potter, Luc de Montigny, Jean Paquet, Massimiliano Iseppon |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Canada Emergency Medical Services Defibrillation medicine.medical_treatment Electric Countershock Context (language use) Logistic regression Odds Cohort Studies 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine business.industry 030208 emergency & critical care medicine Odds ratio Middle Aged Prognosis Confidence interval Patient Discharge Emergency medicine Cohort Emergency Medicine Female business Out-of-Hospital Cardiac Arrest Cohort study |
| Zdroj: | CJEM. 21(3) |
| ISSN: | 1481-8043 1481-8035 |
| Popis: | ObjectivesPatients suffering from an out-of-hospital cardiac arrest (OHCA) associated with an initial shockable rhythm have a better prognosis than their counterparts. The implications of recurrent or refractory malignant arrhythmia in such context remain unclear. The objective of this study is to evaluate the association between the number of prehospital shocks delivered and survival to hospital discharge among patients in OHCA.MethodsThis cohort study included adult patients with an initial shockable rhythm over a 5-year period from a registry of OHCA in Montreal, Canada. The relationship between the number of prehospital shocks delivered and survival to discharge was described using dynamic probabilities. The association between the number of prehospital shocks delivered and survival to discharge was assessed using multivariable logistic regression.ResultsA total of 1,788 patients (78% male with a mean age of 64 years) were included in this analysis, of whom 536 (30%) received treatments from an advanced care paramedic. A third of the cohort (583 patients, 33%) survived to hospital discharge. The probability of survival was highest with the first shock (33% [95% confidence interval 30%-35%]), but decreased to 8% (95% confidence interval 4%-13%) following nine shocks. A higher number of prehospital shocks was independently associated with lower odds of survival (adjusted odds ratio=0.88 [95% confidence interval 0.85-0.92], p < 0.001).ConclusionSurvival remains possible even after a high number of shocks for patients suffering from an OHCA with an initial shockable rhythm. However, requiring more shocks is independently associated with worse survival. |
| Databáze: | OpenAIRE |
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