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Resuscitation. 2017 May;114:157-163. doi: 10.1016/j.resuscitation.2016.12.021. Epub 2017 Jan 11.

Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology.

Author information

1
Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark. Electronic address: shahzleen@gmail.com.
2
Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen, Denmark.
3
Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark.
4
Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark; Duke Clinical Research Institute, Duke University, Durham, NC, United States.
5
Department of Anesthesiology & Clinical Medicine, Aalborg University, Aalborg University Hospital, Denmark.
6
Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
7
Emergency Medical Services Copenhagen, University of Copenhagen, Denmark.
8
Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark.
9
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark.
10
The National Institute of Public Health, University of Southern Denmark, Denmark.
11
Department of Health, Science and Technology, Aalborg University, and Aalborg University Hospital, Aalborg, Denmark.
12
Emergency Medical Services Copenhagen, University of Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark.

Abstract

BACKGROUND:

Knowledge about heart rhythm conversion from non-shockable to shockable rhythm during resuscitation attempt after out-of-hospital cardiac arrest (OHCA) and following chance of survival is limited and inconsistent.

METHODS:

We studied 13,860 patients with presumed cardiac-caused OHCA not witnessed by the emergency medical services from the Danish Cardiac Arrest Register (2005-2012). Patients were stratified according to rhythm: shockable, converted shockable (based on receipt of subsequent defibrillation) and sustained non-shockable rhythm. Multiple logistic regression was used to identify predictors of rhythm conversion and to compute 30-day survival chances.

RESULTS:

Twenty-five percent of patients who received pre-hospital defibrillation by ambulance personnel were initially found in non-shockable rhythms. Younger age, males, witnessed arrest, shorter response time, and heart disease were significantly associated with conversion to shockable rhythm, while psychiatric- and chronic obstructive pulmonary disease were significantly associated with sustained non-shockable rhythm. Compared to sustained non-shockable rhythms, converted shockable rhythms and initial shockable rhythms were significantly associated with increased 30-day survival (Adjusted odds ratio (OR) 2.6, 95% confidence interval (CI): 1.8-3.8; and OR 16.4, 95% CI 12.7-21.2, respectively). From 2005 to 2012, 30-day survival chances increased significantly for all three groups: shockable rhythms, from 16.3% (CI: 14.2%-18.7%) to 35.7% (CI: 32.5%-38.9%); converted rhythms, from 2.1% (CI: 1.6%-2.9%) to 5.8% (CI: 4.4%-7.6%); and sustained non-shockable rhythms, from 0.6% (CI: 0.5%-0.8%) to 1.8% (CI: 1.4%-2.2%).

CONCLUSION:

Converting to shockable rhythm during resuscitation attempt was common and associated with nearly a three-fold higher odds of 30-day survival compared to sustained non-shockable rhythms.

KEYWORDS:

Arrhythmia; Converted rhythm; Defibrillation; Epidemiology; Out-of-hospital cardiac arrest; Survival

[Indexed for MEDLINE]

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