Format

Send to

Choose Destination
Crit Care. 2015 Sep 10;19:322. doi: 10.1186/s13054-015-1028-0.

Subsequent shock deliveries are associated with increased favorable neurological outcomes in cardiac arrest patients who had initially non-shockable rhythms.

Author information

1
Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu-City, Chiba, 292-8535, Japan. kitaccm-cib@umin.ac.jp.
2
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-City, Chiba, 260-8677, Japan. taka.nakada@nifty.com.
3
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-City, Chiba, 260-8677, Japan. shino@gk9.so-net.ne.jp.
4
National Cerebral and Cardiovascular Center Hospital, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. tahara@ncvc.go.jp.
5
Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-0032, Japan. sakurai.atsushi@nihon-u.ac.jp.
6
National Center of Neurology and Psychiatry, Translational Medical Center, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan. nyonemoto@gmail.com.
7
Nihon University Surugadai Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan. nagao.ken@nihon-u.ac.jp.
8
Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan. ayaguchi@ccmc.twmu.ac.jp.
9
Department of Emergency Medicine, Yokohama City University Medical Center, 4 -57 Urafunecho, Minami-ku, Yokohama-City, Kanagawa, 232-0024, Japan. molimula@r6.dion.ne.jp.

Abstract

INTRODUCTION:

Previous studies evaluating whether subsequent conversion to shockable rhythms in patients who had initially non-shockable rhythms was associated with altered clinical outcome reported inconsistent results. Therefore, we hypothesized that subsequent shock delivery by emergency medical service (EMS) providers altered clinical outcomes in patients with initially non-shockable rhythms.

METHODS:

We tested for an association between subsequent shock delivery in EMS resuscitation and clinical outcomes in patients with initially non-shockable rhythms (n = 11,481) through a survey of patients after out-of-hospital cardiac arrest in the Kanto region (SOS-KANTO) 2012 study cohort, Japan. The primary investigated outcome was 1-month survival with favorable neurological functions. The secondary outcome variable was the presence of subsequent shock delivery. We further evaluated the association of interval from initiation of cardiopulmonary resuscitation to shock with clinical outcomes.

RESULTS:

In the univariate analysis of initially non-shockable rhythms, patients who received subsequent shock delivery had significantly increased frequency of return of spontaneous circulation, 24-hour survival, 1-month survival, and favorable neurological outcomes compared to the subsequent not shocked group (P < 0.0001). In the multivariate logistic regression analysis, subsequent shock was significantly associated with favorable neurological outcomes (vs. not shocked; adjusted P = 0.0020, odds ratio, 2.78; 95% confidence interval, 1.45-5.30). Younger age, witnessed arrest, initial pulseless electrical activity rhythms, and cardiac etiology were significantly associated with the presence of subsequent shock in patients with initially non-shockable rhythms.

CONCLUSIONS:

In this study of cardiac arrest patients with initially non-shockable rhythms, patients who received early defibrillation by EMS providers had increased 1-month favorable neurological outcomes.

PMID:
26353809
PMCID:
PMC4565021
DOI:
10.1186/s13054-015-1028-0
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center