Author + information
- Yan Xiong1,2,
- Ruiying Zheng1,
- Shengyuan Luo1,
- Jinli Liao1,
- Wanwan Zhang1,
- Jia Xu1 and
- Ahamed H. Idris2
The incidence of out-of hospital cardiac arrest (OHCA) with initially non-shockable rhythms, Pulseless Electrical Activity (PEA) and Asystole, is reported to be increased and researchers found that conversion from initially non-shockable rhythms to shockable rhythms may be utilized for prognosis prediction. In this study, we were to determine whether the conversion to shockable rhythms and the subsequent reception of shocks is indeed a reliable indicator towards better survival outcomes in both OHCA patients who initially presented with pulseless electrical activity (PEA) and those presenting with asystole, and whether any differences existed between those two populations.
A secondary analysis on the Resuscitation Outcomes Consortium (ROC) PRIMED dataset was performed. The primary outcome was survival to hospital discharge and the secondary outcome was prehospital return to spontaneous circulation (ROSC) in the field. We compared outcomes using chi-square analysis and uni-variable logistic analysis and adjusted them for confounders via multivariable logistic regression.
Of the 9,902 included cases, 3415 (34.5%) were initially in PEA and 6487 (65.5%) were in asystole. 744 (21.8%) PEA patients and 1,134 (17.5%) asystolic patients underwent rhythm conversions and received subsequent shocks. The adjusted odds ratios (ORs) for prehospital ROSC and survival to discharge were 1.862 (95%CI, 1.590-2.180;p=0.000) and 3.778 (95%CI, 2.374-6.014; p=0.000) respectively in subsequently shocked asystolic patients, and 1.115 (95%CI 0.720-1.726) and 0.951 (95%CI 0.796-1.137) respectively in subsequently shocked PEA patients.
The conversion to shockable rhythms and subsequent reception of shocks were associated with higher odds for prehospital ROSC and survival to hospital discharge in initially asystolic OHCA patients, whereas such associations were not observed in patients whose initial rhythms were PEA.