Abstract
In patients with out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm, the prognostic significance of conversion to a shockable rhythm (or hereafter “conversion”) during resuscitation remains unclear. We investigated whether conversion is associated with good neurologic outcome. We included patients with OHCA with medical causes and an initial non-shockable rhythm by using the national OHCA surveillance cohort database of the Korea Centers for Disease Control and Prevention for 2012~2016. The primary outcome was good neurologic outcome at hospital discharge. Of 85,602 patients with an initial non-shockable rhythm, 17.9% experienced conversion. Patients with and those without conversion had good neurologic outcome rates of 3.2% and 1.0%, respectively (p < 0.001). In multiple regression analysis, conversion was associated with good neurologic outcome (adjusted odds ratio (OR) 2.604; 95% confidence interval (CI) 2.248–3.015) in the patients with an initial non-shockable rhythm, and had the association with good neurologic outcome (adjusted OR 3.972, 95% CI 3.167–4.983) in unwitnessed patients by emergency medical services (EMS) without pre-hospital return of spontaneous circulation (ROSC) among the population. In patients with OHCA with an initial non-shockable rhythm, even if with unwitnessed arrest by EMS and no pre-hospital ROSC, continuing resuscitation needs to be considered if conversion to a shockable rhythm occurred.
Highlights
Patients with out-of-hospital cardiac arrest (OHCA) have good neurological prognoses when the initial rhythm is shockable [1,2,3]
In OHCA patients not witnessed by emergency medical services (EMS), initial non-shockable rhythm and no return of spontaneous circulation (ROSC) in the pre-hospital setting, conversion to a shockable rhythm is an important determinant in maintaining resuscitation due to the Universal Termination of Resuscitation (TOR) Guidelines [7]
We investigated whether conversion to a shockable rhythm is associated with good neurologic outcome according to the pre-hospital ROSC status and the state of being witnessed by an EMS provider in the patients with initial non-shockable rhythm, based on the Korean national OHCA Surveillance database [10]
Summary
Patients with out-of-hospital cardiac arrest (OHCA) have good neurological prognoses when the initial rhythm is shockable [1,2,3]. Those patients with an initial non-shockable rhythm who during cardiopulmonary resuscitation (CPR) convert to a shockable rhythm may have a good prognosis [4]. In OHCA patients not witnessed by emergency medical services (EMS), initial non-shockable rhythm and no return of spontaneous circulation (ROSC) in the pre-hospital setting, conversion to a shockable rhythm is an important determinant in maintaining resuscitation due to the Universal Termination of Resuscitation (TOR) Guidelines [7]. A prerequisite for TOR are: (1) cardiac arrest not witnessed by EMS. (2) no ROSC. (3) no shock was delivered [7,8,9]
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