Can We Predict Good Survival Outcomes by Classifying Initial and Re-Arrest Rhythm Change Patterns in Out-of-Hospital Cardiac Arrest Settings?

Heejun Shin,Kyoungmi Lee,Giwoon Kim,Yongjin Park,Hanjoo Choi,Hyungjun Moon,Hyuk Joong Choi,Choung Ah Lee,Wonjung Jeong,Younghwan Lee

doi:10.7759/cureus.12019

Abstract

ObjectiveThe purpose of this study was to investigate whether a change in prehospital arrest rhythms could allow medical personnel to predict survival outcomes in patients who achieved a return of spontaneous circulation (ROSC) in the setting of out-of-hospital cardiac arrest (OHCA).MethodsThe design of this study was retrospective, multi-regional, observational, and cross-sectional with a determining period between August 2015 and July 2016. Cardiac arrest rhythms were defined as a shockable rhythm (S), which refers to ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), and non-shockable rhythm (NS), which refers to pulseless electrical activity or asystole. Survival to admission, survival to discharge, and good cerebral performance category (CPC) (CPC 1 or 2) were defined as good survival outcomes.ResultsA total of 163 subjects were classified into four groups according to the rhythm change pattern: NS→NS (98), S→S (27), S→NS (23), and NS→S (15). NS→NS pattern was used as the reference in logistic regression analysis. In the case of survival to hospital admission, the odds ratio (OR) (95% CI) of the S→S pattern was the highest [12.63 (3.56-44.85), p: <0.001 by no correction] and [7.29 (1.96-27.10), p = 0.003 with adjusting]. In the case of survival to hospital discharge, the OR (95% CI) of the S→S pattern was the highest [37.14 (11.71-117.78), p: <0.001 by no correction] and [13.85 (3.69-51.97), p: <0.001 with adjusting]. In the case of good CPC (CPC 1 or 2) at discharge, the OR (95% CI) of the S→S pattern was the highest [96 (19.14-481.60), p: <0.001 by no correction] and [149.69 (19.51-1148.48), p: <0.001 with adjusting].ConclusionsThe S→S group showed the highest correlation with survival to hospital admission, survival to hospital discharge, and good CPC (CPC 1 or 2) at discharge compared to the NS→NS group. Verifying changes in initial cardiac arrest rhythm and prehospital re-arrest (RA) rhythm patterns after prehospital ROSC can help us predict good survival outcomes in the OHCA setting.

Highlights

The increasing frequency of recurrent cardiac re-arrest (RA) in out-of-hospital cardiac arrest (OHCA) may cause medical staff to predict poor survival [1]
In the case of survival to hospital admission, the odds ratio (OR) of the S→S pattern was the highest [12.63 (3.56-44.85), p:
The S→S group showed the highest correlation with survival to hospital admission, survival to hospital discharge, and good cerebral performance category (CPC) (CPC 1 or 2) at discharge compared to the nonshockable rhythm (NS)→NS group

Summary

Introduction

The increasing frequency of recurrent cardiac re-arrest (RA) in out-of-hospital cardiac arrest (OHCA) may cause medical staff to predict poor survival [1]. In 2015, the variable of "number of cardiac arrests attended" was newly added to the system description of the International Consensus on Cardiopulmonary Resuscitation consensus statement. This variable is one of the five OHCA Utstein definitions added to the Utstein Resuscitation Registry Templates. How to cite this article Shin H, Kim G, Lee Y, et al (December 10, 2020) Can We Predict Good Survival Outcomes by Classifying Initial and Re-Arrest Rhythm Change Patterns in Out-of-Hospital Cardiac Arrest Settings?.

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