TY - JOUR
T1 - Out-of-hospital cardiac arrest patients with implantable cardioverter-defibrillators
T2 - What are their outcomes?
AU - Li, Jie
AU - Zhang, Yongshu
AU - Long, Ming
AU - Liu, Menghui
AU - Zhang, Wanwan
AU - Gu, Liwen
AU - Su, Chen
AU - Xiong, Yan
AU - Wang, Lichun
AU - Idris, Ahamed
N1 - Funding Information:
We would like to thank the National Institute of Health of the United States for making this de-identified dataset of ROC research resource available for public application and use. We are also indebted to all people including the firefighters and paramedics who participated in ROC clinical research for their extraordinary diligence, hard work and dedication. We thank Julia Jenkins, PhD and Hanne Gadeberg, PhD, from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/12
Y1 - 2020/12
N2 - The aim of the study: To identify the prognostic factors and effects of implantable cardioverter-defibrillators (ICDs) in out-of-hospital cardiac arrest (OHCA) patients with ICDs because the clinical characteristics and outcomes of OHCA patients with ICDs are unknown. Methods: The North American Resuscitation Outcomes Consortium (ROC) Cardiac Epistry Version 3 dataset was analyzed. Eligible patients were divided into OHCA patients with and without ICDs. Multivariable regressions were employed to analyze. Results: Of 51,634 eligible OHCA patients, 581 (1.13%) had implanted ICDs. Among them, 53 (9.1%) patients survived to hospital discharge, and 40 (6.9%) patients had favorable neurological outcome at hospital discharge. Multivariable regression showed ICDs were not associated with OHCA outcomes in the total OHCA patients. In the OHCA patients with ICDs, shockable initial emergency medical services (EMS)-recorded rhythms and the ICD-shock-only defibrillation pattern were independent favorable factors for survival to hospital discharge(OR = 3.3, 95%CI 1.7–6.2, P < 0.001; OR = 2.4, 95%CI 1.1–5.5, P = 0.035, respectively) and neurological outcome at hospital discharge (OR = 6.5, 95%CI 2.9–14.4, P < 0.001; OR = 3.6, 95%CI 1.4–9.1, P = 0.006, respectively). During field resuscitation in OHCA patients with ICDs, at least 34.9% of total patients and 64.6% of patients with initial EMS-recorded VT/VF rhythms needed additional external shocks. Conclusions: Shockable initial EMS-recorded rhythms and ICD-shock-only defibrillation pattern were independent factors for the favorable outcomes of OHCA patients with ICDs. ICDs were not associated with the outcomes of OHCA, and additional external shocks were needed in a substantial number of OHCA patients with ICDs during field resuscitation.
AB - The aim of the study: To identify the prognostic factors and effects of implantable cardioverter-defibrillators (ICDs) in out-of-hospital cardiac arrest (OHCA) patients with ICDs because the clinical characteristics and outcomes of OHCA patients with ICDs are unknown. Methods: The North American Resuscitation Outcomes Consortium (ROC) Cardiac Epistry Version 3 dataset was analyzed. Eligible patients were divided into OHCA patients with and without ICDs. Multivariable regressions were employed to analyze. Results: Of 51,634 eligible OHCA patients, 581 (1.13%) had implanted ICDs. Among them, 53 (9.1%) patients survived to hospital discharge, and 40 (6.9%) patients had favorable neurological outcome at hospital discharge. Multivariable regression showed ICDs were not associated with OHCA outcomes in the total OHCA patients. In the OHCA patients with ICDs, shockable initial emergency medical services (EMS)-recorded rhythms and the ICD-shock-only defibrillation pattern were independent favorable factors for survival to hospital discharge(OR = 3.3, 95%CI 1.7–6.2, P < 0.001; OR = 2.4, 95%CI 1.1–5.5, P = 0.035, respectively) and neurological outcome at hospital discharge (OR = 6.5, 95%CI 2.9–14.4, P < 0.001; OR = 3.6, 95%CI 1.4–9.1, P = 0.006, respectively). During field resuscitation in OHCA patients with ICDs, at least 34.9% of total patients and 64.6% of patients with initial EMS-recorded VT/VF rhythms needed additional external shocks. Conclusions: Shockable initial EMS-recorded rhythms and ICD-shock-only defibrillation pattern were independent factors for the favorable outcomes of OHCA patients with ICDs. ICDs were not associated with the outcomes of OHCA, and additional external shocks were needed in a substantial number of OHCA patients with ICDs during field resuscitation.
KW - Defibrillation
KW - Implantable cardioverter-defibrillator
KW - Outcomes
KW - of-hospital- cardiac arrest
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U2 - 10.1016/j.resuscitation.2020.10.016
DO - 10.1016/j.resuscitation.2020.10.016
M3 - Article
C2 - 33191208
AN - SCOPUS:85096223314
SN - 0300-9572
VL - 157
SP - 141
EP - 148
JO - Resuscitation
JF - Resuscitation
ER -