Conversion to shockable rhythms is associated with better outcomes in out-of-hospital cardiac arrest patients with initial asystole but not in those with pulseless electrical activity

Ruiying Zheng, Shengyuan Luo, Jinli Liao, Zhihao Liu, Jia Xu, Hong Zhan, Xiaoxing Liao, Yan Xiong, Ahamed Idris

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background The prognostic implication of conversion from initially non-shockable to shockable rhythms in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. Our objective is to determine whether the conversion to shockable rhythms is a reliable predictor of short- and long-term outcomes both in patients who initially presented with pulseless electrical activity (PEA) and in those with asystole. Methods A secondary analysis was performed on non-traumatic OHCA cases ≥18 years old with PEA or asystole as initial rhythms, who were treated in the field and enrolled in the Resuscitation Outcomes Consortium (ROC) PRIMED study (clinicaltrials.gov/ct2/show/NCT00394706). We reported the characteristics and outcomes for those patients with or without shocks delivered in the field. Logistic regression analysis assessed the association of shock delivery with pre-hospital return of spontaneous circulation (ROSC), survival to hospital discharge and favorable neurological outcome as well. Results Of the 9902 included cases, 3415 (34.5%) were initially in PEA and 6487 (65.5%) were in asystole. 744 (21.8%) PEA and 1134 (17.5%) asystolic patients underwent rhythm conversions and received subsequent shocks. For asystolic patients, the adjusted odds ratios (ORs) of shock delivery for pre-hospital ROSC, survival to discharge and favorable neurological outcome were 1.862 (95%CI 1.590–2.180), 3.778 (95%CI 2.374–6.014) and 4.154 (95%CI 2.192–7.871) respectively, while for PEA patients they were 0.951 (95%CI 0.796–1.137), 1.115 (95%CI 0.720–1.726) and 1.373 (95%CI 0.790–2.385) respectively. Conclusions Conversion to shockable rhythms was associated with better outcomes in initially asystolic OHCA patients, whereas such associations were not observed in patients initially in PEA.

Original languageEnglish (US)
Pages (from-to)88-93
Number of pages6
JournalResuscitation
Volume107
DOIs
StatePublished - Oct 1 2016

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Out-of-Hospital Cardiac Arrest
Heart Arrest
Shock
Survival
Resuscitation
Logistic Models
Odds Ratio
Regression Analysis

Keywords

  • Asystole
  • Cardiac arrest
  • Defibrillation
  • Outcomes
  • Pulseless electrical activity

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Conversion to shockable rhythms is associated with better outcomes in out-of-hospital cardiac arrest patients with initial asystole but not in those with pulseless electrical activity. / Zheng, Ruiying; Luo, Shengyuan; Liao, Jinli; Liu, Zhihao; Xu, Jia; Zhan, Hong; Liao, Xiaoxing; Xiong, Yan; Idris, Ahamed.

In: Resuscitation, Vol. 107, 01.10.2016, p. 88-93.

Research output: Contribution to journalArticle

Zheng, Ruiying ; Luo, Shengyuan ; Liao, Jinli ; Liu, Zhihao ; Xu, Jia ; Zhan, Hong ; Liao, Xiaoxing ; Xiong, Yan ; Idris, Ahamed. / Conversion to shockable rhythms is associated with better outcomes in out-of-hospital cardiac arrest patients with initial asystole but not in those with pulseless electrical activity. In: Resuscitation. 2016 ; Vol. 107. pp. 88-93.
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abstract = "Background The prognostic implication of conversion from initially non-shockable to shockable rhythms in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. Our objective is to determine whether the conversion to shockable rhythms is a reliable predictor of short- and long-term outcomes both in patients who initially presented with pulseless electrical activity (PEA) and in those with asystole. Methods A secondary analysis was performed on non-traumatic OHCA cases ≥18 years old with PEA or asystole as initial rhythms, who were treated in the field and enrolled in the Resuscitation Outcomes Consortium (ROC) PRIMED study (clinicaltrials.gov/ct2/show/NCT00394706). We reported the characteristics and outcomes for those patients with or without shocks delivered in the field. Logistic regression analysis assessed the association of shock delivery with pre-hospital return of spontaneous circulation (ROSC), survival to hospital discharge and favorable neurological outcome as well. Results Of the 9902 included cases, 3415 (34.5{\%}) were initially in PEA and 6487 (65.5{\%}) were in asystole. 744 (21.8{\%}) PEA and 1134 (17.5{\%}) asystolic patients underwent rhythm conversions and received subsequent shocks. For asystolic patients, the adjusted odds ratios (ORs) of shock delivery for pre-hospital ROSC, survival to discharge and favorable neurological outcome were 1.862 (95{\%}CI 1.590–2.180), 3.778 (95{\%}CI 2.374–6.014) and 4.154 (95{\%}CI 2.192–7.871) respectively, while for PEA patients they were 0.951 (95{\%}CI 0.796–1.137), 1.115 (95{\%}CI 0.720–1.726) and 1.373 (95{\%}CI 0.790–2.385) respectively. Conclusions Conversion to shockable rhythms was associated with better outcomes in initially asystolic OHCA patients, whereas such associations were not observed in patients initially in PEA.",
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T1 - Conversion to shockable rhythms is associated with better outcomes in out-of-hospital cardiac arrest patients with initial asystole but not in those with pulseless electrical activity

AU - Zheng, Ruiying

AU - Luo, Shengyuan

AU - Liao, Jinli

AU - Liu, Zhihao

AU - Xu, Jia

AU - Zhan, Hong

AU - Liao, Xiaoxing

AU - Xiong, Yan

AU - Idris, Ahamed

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background The prognostic implication of conversion from initially non-shockable to shockable rhythms in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. Our objective is to determine whether the conversion to shockable rhythms is a reliable predictor of short- and long-term outcomes both in patients who initially presented with pulseless electrical activity (PEA) and in those with asystole. Methods A secondary analysis was performed on non-traumatic OHCA cases ≥18 years old with PEA or asystole as initial rhythms, who were treated in the field and enrolled in the Resuscitation Outcomes Consortium (ROC) PRIMED study (clinicaltrials.gov/ct2/show/NCT00394706). We reported the characteristics and outcomes for those patients with or without shocks delivered in the field. Logistic regression analysis assessed the association of shock delivery with pre-hospital return of spontaneous circulation (ROSC), survival to hospital discharge and favorable neurological outcome as well. Results Of the 9902 included cases, 3415 (34.5%) were initially in PEA and 6487 (65.5%) were in asystole. 744 (21.8%) PEA and 1134 (17.5%) asystolic patients underwent rhythm conversions and received subsequent shocks. For asystolic patients, the adjusted odds ratios (ORs) of shock delivery for pre-hospital ROSC, survival to discharge and favorable neurological outcome were 1.862 (95%CI 1.590–2.180), 3.778 (95%CI 2.374–6.014) and 4.154 (95%CI 2.192–7.871) respectively, while for PEA patients they were 0.951 (95%CI 0.796–1.137), 1.115 (95%CI 0.720–1.726) and 1.373 (95%CI 0.790–2.385) respectively. Conclusions Conversion to shockable rhythms was associated with better outcomes in initially asystolic OHCA patients, whereas such associations were not observed in patients initially in PEA.

AB - Background The prognostic implication of conversion from initially non-shockable to shockable rhythms in patients with out-of-hospital cardiac arrest (OHCA) remains unclear. Our objective is to determine whether the conversion to shockable rhythms is a reliable predictor of short- and long-term outcomes both in patients who initially presented with pulseless electrical activity (PEA) and in those with asystole. Methods A secondary analysis was performed on non-traumatic OHCA cases ≥18 years old with PEA or asystole as initial rhythms, who were treated in the field and enrolled in the Resuscitation Outcomes Consortium (ROC) PRIMED study (clinicaltrials.gov/ct2/show/NCT00394706). We reported the characteristics and outcomes for those patients with or without shocks delivered in the field. Logistic regression analysis assessed the association of shock delivery with pre-hospital return of spontaneous circulation (ROSC), survival to hospital discharge and favorable neurological outcome as well. Results Of the 9902 included cases, 3415 (34.5%) were initially in PEA and 6487 (65.5%) were in asystole. 744 (21.8%) PEA and 1134 (17.5%) asystolic patients underwent rhythm conversions and received subsequent shocks. For asystolic patients, the adjusted odds ratios (ORs) of shock delivery for pre-hospital ROSC, survival to discharge and favorable neurological outcome were 1.862 (95%CI 1.590–2.180), 3.778 (95%CI 2.374–6.014) and 4.154 (95%CI 2.192–7.871) respectively, while for PEA patients they were 0.951 (95%CI 0.796–1.137), 1.115 (95%CI 0.720–1.726) and 1.373 (95%CI 0.790–2.385) respectively. Conclusions Conversion to shockable rhythms was associated with better outcomes in initially asystolic OHCA patients, whereas such associations were not observed in patients initially in PEA.

KW - Asystole

KW - Cardiac arrest

KW - Defibrillation

KW - Outcomes

KW - Pulseless electrical activity

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