Subsequent ventricular fibrillation and survival in out-of-hospital cardiac arrests presenting with PEA or asystole

Kentaro Kajino, Taku Iwami, Mohamud Ramzan Daya, Tatsuya Nishiuchi, Yasuyuki Hayashi, Hisashi Ikeuchi, Hiroshi Tanaka, Takeshi Shimazu, Hisashi Sugimoto

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: The prognostic implications of conversion to ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OHCA) patients with an initial non-shockable rhythm are unclear. Hypothesis: Among OHCA patients with an initial non-shockable rhythm, survival is better in individuals who subsequently develop VF and are defibrillated. Methods: Design: Utstein style population-based cohort study. Subjects: adults (age ≧ 18 years) with OHCA of presumed cardiac etiology and initial rhythm of pulseless electrical activity (PEA) or asystole treated by emergency medical services systems in Osaka, Japan from January 1, 2001 to December 31, 2005. Primary outcome measure was one-month neurologically favorable survival (CPC ≤ 2). Outcome of patients with subsequent VF (SHOCK group) was compared to that of patients with sustained non-shockable rhythm (NON-SHOCK group) using logistic regression to adjust for potential confounding variables. Results: Of 14,316 OHCA, 12,353 cases had PEA or asystole as the initial rhythm. Of these, 11,766 (95%) remained in a non-shockable rhythm throughout the resuscitation effort while 587 (5%) subsequently developed VF and were defibrillated. Neurologically favorable survival at one month was significantly better in the SHOCK group (6% versus 1%, p <0.001). Subsequent VF remained a significant predictor (OR, 4.3; 95% CI, 2.8-6.7) of neurologically favorable survival after adjustment for potential confounders. Conclusions: Based on a large-scaled population-based cohort of OHCA, subsequent VF with defibrillation was associated with better outcomes among patients with an initial non-shockable rhythm.

Original languageEnglish (US)
Pages (from-to)34-40
Number of pages7
JournalResuscitation
Volume79
Issue number1
DOIs
StatePublished - Oct 2008

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Out-of-Hospital Cardiac Arrest
Ventricular Fibrillation
Heart Arrest
Survival
Confounding Factors (Epidemiology)
Emergency Medical Services
Resuscitation
Population
Japan
Cohort Studies
Logistic Models
Outcome Assessment (Health Care)

Keywords

  • Asystole
  • Cardiopulmonary resuscitation (CPR)
  • Emergency medical services (EMS)
  • Out-of-hospital Cardiac Arrest (OHCA)
  • Pulseless electrical activity (PEA)
  • Return of spontaneous circulation (ROSC)
  • Ventricular fibrillation (VF)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Subsequent ventricular fibrillation and survival in out-of-hospital cardiac arrests presenting with PEA or asystole. / Kajino, Kentaro; Iwami, Taku; Daya, Mohamud Ramzan; Nishiuchi, Tatsuya; Hayashi, Yasuyuki; Ikeuchi, Hisashi; Tanaka, Hiroshi; Shimazu, Takeshi; Sugimoto, Hisashi.

In: Resuscitation, Vol. 79, No. 1, 10.2008, p. 34-40.

Research output: Contribution to journalArticle

Kajino, K, Iwami, T, Daya, MR, Nishiuchi, T, Hayashi, Y, Ikeuchi, H, Tanaka, H, Shimazu, T & Sugimoto, H 2008, 'Subsequent ventricular fibrillation and survival in out-of-hospital cardiac arrests presenting with PEA or asystole', Resuscitation, vol. 79, no. 1, pp. 34-40. https://doi.org/10.1016/j.resuscitation.2008.05.017
Kajino, Kentaro ; Iwami, Taku ; Daya, Mohamud Ramzan ; Nishiuchi, Tatsuya ; Hayashi, Yasuyuki ; Ikeuchi, Hisashi ; Tanaka, Hiroshi ; Shimazu, Takeshi ; Sugimoto, Hisashi. / Subsequent ventricular fibrillation and survival in out-of-hospital cardiac arrests presenting with PEA or asystole. In: Resuscitation. 2008 ; Vol. 79, No. 1. pp. 34-40.
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abstract = "Background: The prognostic implications of conversion to ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OHCA) patients with an initial non-shockable rhythm are unclear. Hypothesis: Among OHCA patients with an initial non-shockable rhythm, survival is better in individuals who subsequently develop VF and are defibrillated. Methods: Design: Utstein style population-based cohort study. Subjects: adults (age ≧ 18 years) with OHCA of presumed cardiac etiology and initial rhythm of pulseless electrical activity (PEA) or asystole treated by emergency medical services systems in Osaka, Japan from January 1, 2001 to December 31, 2005. Primary outcome measure was one-month neurologically favorable survival (CPC ≤ 2). Outcome of patients with subsequent VF (SHOCK group) was compared to that of patients with sustained non-shockable rhythm (NON-SHOCK group) using logistic regression to adjust for potential confounding variables. Results: Of 14,316 OHCA, 12,353 cases had PEA or asystole as the initial rhythm. Of these, 11,766 (95{\%}) remained in a non-shockable rhythm throughout the resuscitation effort while 587 (5{\%}) subsequently developed VF and were defibrillated. Neurologically favorable survival at one month was significantly better in the SHOCK group (6{\%} versus 1{\%}, p <0.001). Subsequent VF remained a significant predictor (OR, 4.3; 95{\%} CI, 2.8-6.7) of neurologically favorable survival after adjustment for potential confounders. Conclusions: Based on a large-scaled population-based cohort of OHCA, subsequent VF with defibrillation was associated with better outcomes among patients with an initial non-shockable rhythm.",
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T1 - Subsequent ventricular fibrillation and survival in out-of-hospital cardiac arrests presenting with PEA or asystole

AU - Kajino, Kentaro

AU - Iwami, Taku

AU - Daya, Mohamud Ramzan

AU - Nishiuchi, Tatsuya

AU - Hayashi, Yasuyuki

AU - Ikeuchi, Hisashi

AU - Tanaka, Hiroshi

AU - Shimazu, Takeshi

AU - Sugimoto, Hisashi

PY - 2008/10

Y1 - 2008/10

N2 - Background: The prognostic implications of conversion to ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OHCA) patients with an initial non-shockable rhythm are unclear. Hypothesis: Among OHCA patients with an initial non-shockable rhythm, survival is better in individuals who subsequently develop VF and are defibrillated. Methods: Design: Utstein style population-based cohort study. Subjects: adults (age ≧ 18 years) with OHCA of presumed cardiac etiology and initial rhythm of pulseless electrical activity (PEA) or asystole treated by emergency medical services systems in Osaka, Japan from January 1, 2001 to December 31, 2005. Primary outcome measure was one-month neurologically favorable survival (CPC ≤ 2). Outcome of patients with subsequent VF (SHOCK group) was compared to that of patients with sustained non-shockable rhythm (NON-SHOCK group) using logistic regression to adjust for potential confounding variables. Results: Of 14,316 OHCA, 12,353 cases had PEA or asystole as the initial rhythm. Of these, 11,766 (95%) remained in a non-shockable rhythm throughout the resuscitation effort while 587 (5%) subsequently developed VF and were defibrillated. Neurologically favorable survival at one month was significantly better in the SHOCK group (6% versus 1%, p <0.001). Subsequent VF remained a significant predictor (OR, 4.3; 95% CI, 2.8-6.7) of neurologically favorable survival after adjustment for potential confounders. Conclusions: Based on a large-scaled population-based cohort of OHCA, subsequent VF with defibrillation was associated with better outcomes among patients with an initial non-shockable rhythm.

AB - Background: The prognostic implications of conversion to ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OHCA) patients with an initial non-shockable rhythm are unclear. Hypothesis: Among OHCA patients with an initial non-shockable rhythm, survival is better in individuals who subsequently develop VF and are defibrillated. Methods: Design: Utstein style population-based cohort study. Subjects: adults (age ≧ 18 years) with OHCA of presumed cardiac etiology and initial rhythm of pulseless electrical activity (PEA) or asystole treated by emergency medical services systems in Osaka, Japan from January 1, 2001 to December 31, 2005. Primary outcome measure was one-month neurologically favorable survival (CPC ≤ 2). Outcome of patients with subsequent VF (SHOCK group) was compared to that of patients with sustained non-shockable rhythm (NON-SHOCK group) using logistic regression to adjust for potential confounding variables. Results: Of 14,316 OHCA, 12,353 cases had PEA or asystole as the initial rhythm. Of these, 11,766 (95%) remained in a non-shockable rhythm throughout the resuscitation effort while 587 (5%) subsequently developed VF and were defibrillated. Neurologically favorable survival at one month was significantly better in the SHOCK group (6% versus 1%, p <0.001). Subsequent VF remained a significant predictor (OR, 4.3; 95% CI, 2.8-6.7) of neurologically favorable survival after adjustment for potential confounders. Conclusions: Based on a large-scaled population-based cohort of OHCA, subsequent VF with defibrillation was associated with better outcomes among patients with an initial non-shockable rhythm.

KW - Asystole

KW - Cardiopulmonary resuscitation (CPR)

KW - Emergency medical services (EMS)

KW - Out-of-hospital Cardiac Arrest (OHCA)

KW - Pulseless electrical activity (PEA)

KW - Return of spontaneous circulation (ROSC)

KW - Ventricular fibrillation (VF)

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