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The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest.

Hasegawa M, Abe T, Nagata T, Onozuka D, Hagihara A - Scand J Trauma Resusc Emerg Med (2015)

Bottom Line: Variables related to the number of defibrillations or one-month survival in OHCA were identified using multiple logistic regression analysis.The number of defibrillations (odds ratio [OR] = 1.19, 95% CI: 1.03, 1.38), OHCA origin (OR = 2.81, 95% CI: 2.26, 3.49), use of ALS devices (OR = 0.68, 95% CI: 0.59, 0.79), use of epinephrine (OR = 0.33, 95% C: 0.28, 0.39), interval between first defibrillation and first ROSC (OR = 1.45, 95% CI: 1.18, 1.78), and chest compression (OR = 1.21, 95% CI: 1.06, 1.38) were associated significantly with 1-month OCHA survival.Further studies are needed to verify this finding.

View Article: PubMed Central - PubMed

Affiliation: Guidance of Medical Service Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, 2-2 Kasumigaseki 1-chome, Chiyoda-ku, Tokyo, 100-8916, Japan. hasegawa-manabu@mhlw.go.jp.

ABSTRACT

Background: The relationship between the number of pre-hospital defibrillation shocks and treatment outcome in patients with out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF) is unknown currently. We examined the association between the number of pre-hospitalization defibrillation shocks and 1-month survival in OHCA patients.

Methods: We conducted a prospective observational study using national registry data obtained from patients with OHCA between January 1, 2009 and December 31, 2012 in Japan. The study subjects were ≥ 18-110 years of age, had suffered from an OHCA before arrival of EMS personnel, had a witnessed collapse, had an initial rhythm that was shockable [VF/ventricular tachycardia (pulseless VT)], were not delivered a shock using a public automated external defibrillator (AED), received one or more shocks using a biphasic defibrillator by EMS personnel, and were transported to a medical institution between January 1, 2009 and December 31, 2012. There were 20,851 OHCA cases which met the inclusion criteria during the study period. Signal detection analysis was used to identify the cutoff point in the number of prehospital defibrillation shocks most closely related to one-month survival. Variables related to the number of defibrillations or one-month survival in OHCA were identified using multiple logistic regression analysis.

Results: A cutoff point in the number of pre-hospital defibrillation shocks most closely associated with 1-month OHCA survival was between two and three (χ(2) = 209.61, p < 0.0001). Among those patients who received two shocks or less, 34.48% survived for at least 1 month, compared with 24.75% of those who received three shocks or more. The number of defibrillations (odds ratio [OR] = 1.19, 95% CI: 1.03, 1.38), OHCA origin (OR = 2.81, 95% CI: 2.26, 3.49), use of ALS devices (OR = 0.68, 95% CI: 0.59, 0.79), use of epinephrine (OR = 0.33, 95% C: 0.28, 0.39), interval between first defibrillation and first ROSC (OR = 1.45, 95% CI: 1.18, 1.78), and chest compression (OR = 1.21, 95% CI: 1.06, 1.38) were associated significantly with 1-month OCHA survival.

Conclusions: The cutoff point in the number of defibrillations of patients with OHCA most closely related to one-month survival was between 2 and 3, and the likelihood of non-survival 1 month after an OHCA was increased when ≥3 shocks were needed. Further studies are needed to verify this finding.

No MeSH data available.


Related in: MedlinePlus

The out-of-hospital cardiac arrest (OHCA) cases evaluated for the analysis. The number of each item in the “NOT ASSESSED FOR ELIGIBILITY” and “EXCLUDED” boxes does not sum up to the total numbers in the boxes due to overlapping items.
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Fig1: The out-of-hospital cardiac arrest (OHCA) cases evaluated for the analysis. The number of each item in the “NOT ASSESSED FOR ELIGIBILITY” and “EXCLUDED” boxes does not sum up to the total numbers in the boxes due to overlapping items.

Mentions: Study subjects in 2009 were resuscitated under the 2005 resuscitation guidelines, and those in 2010, 2011 and 2012 were resuscitated under the 2010 resuscitation guidelines. The study patients were ≥ 18–110 years of age, had suffered from an OHCA before arrival of EMS personnel, had a witnessed collapse, had an initial rhythm that was shockable [VF/ventricular tachycardia (pulseless VT)], were not delivered a shock using a public automated external defibrillator (AED), received one or more shocks using a biphasic defibrillator by EMS personnel, and were transported to a medical institution between January 1, 2009 and December 31, 2012. Because this study aimed to evaluate the association between the number of pre-hospital defibrillations (administered by EMS personnel using a biphasic defibrillator) and 1-month survival after an OHCA, patients administered a shock with a public AED were excluded from the analysis. In addition, patients for whom the time from the call until arrival at the scene was > 60 min or from the call until arrival at the hospital was > 480 min were excluded from the analysis. Of 493,320 OHCA cases between January 1, 2009 and December 31, 2012, 20,851 (4.23%) were used for analysis, and the remaining cases were excluded according to the inclusion criteria (Figure 1). It is notable that >95% of the initial subjects (n = 493,320) were excluded due to multiple inclusion criteria. Since information on a patient’s status 1 month after the event is mandatory in the Utstein template, no patients were lost to follow-up in the study.Figure 1


The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest.

Hasegawa M, Abe T, Nagata T, Onozuka D, Hagihara A - Scand J Trauma Resusc Emerg Med (2015)

The out-of-hospital cardiac arrest (OHCA) cases evaluated for the analysis. The number of each item in the “NOT ASSESSED FOR ELIGIBILITY” and “EXCLUDED” boxes does not sum up to the total numbers in the boxes due to overlapping items.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4404114&req=5

Fig1: The out-of-hospital cardiac arrest (OHCA) cases evaluated for the analysis. The number of each item in the “NOT ASSESSED FOR ELIGIBILITY” and “EXCLUDED” boxes does not sum up to the total numbers in the boxes due to overlapping items.
Mentions: Study subjects in 2009 were resuscitated under the 2005 resuscitation guidelines, and those in 2010, 2011 and 2012 were resuscitated under the 2010 resuscitation guidelines. The study patients were ≥ 18–110 years of age, had suffered from an OHCA before arrival of EMS personnel, had a witnessed collapse, had an initial rhythm that was shockable [VF/ventricular tachycardia (pulseless VT)], were not delivered a shock using a public automated external defibrillator (AED), received one or more shocks using a biphasic defibrillator by EMS personnel, and were transported to a medical institution between January 1, 2009 and December 31, 2012. Because this study aimed to evaluate the association between the number of pre-hospital defibrillations (administered by EMS personnel using a biphasic defibrillator) and 1-month survival after an OHCA, patients administered a shock with a public AED were excluded from the analysis. In addition, patients for whom the time from the call until arrival at the scene was > 60 min or from the call until arrival at the hospital was > 480 min were excluded from the analysis. Of 493,320 OHCA cases between January 1, 2009 and December 31, 2012, 20,851 (4.23%) were used for analysis, and the remaining cases were excluded according to the inclusion criteria (Figure 1). It is notable that >95% of the initial subjects (n = 493,320) were excluded due to multiple inclusion criteria. Since information on a patient’s status 1 month after the event is mandatory in the Utstein template, no patients were lost to follow-up in the study.Figure 1

Bottom Line: Variables related to the number of defibrillations or one-month survival in OHCA were identified using multiple logistic regression analysis.The number of defibrillations (odds ratio [OR] = 1.19, 95% CI: 1.03, 1.38), OHCA origin (OR = 2.81, 95% CI: 2.26, 3.49), use of ALS devices (OR = 0.68, 95% CI: 0.59, 0.79), use of epinephrine (OR = 0.33, 95% C: 0.28, 0.39), interval between first defibrillation and first ROSC (OR = 1.45, 95% CI: 1.18, 1.78), and chest compression (OR = 1.21, 95% CI: 1.06, 1.38) were associated significantly with 1-month OCHA survival.Further studies are needed to verify this finding.

View Article: PubMed Central - PubMed

Affiliation: Guidance of Medical Service Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, 2-2 Kasumigaseki 1-chome, Chiyoda-ku, Tokyo, 100-8916, Japan. hasegawa-manabu@mhlw.go.jp.

ABSTRACT

Background: The relationship between the number of pre-hospital defibrillation shocks and treatment outcome in patients with out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF) is unknown currently. We examined the association between the number of pre-hospitalization defibrillation shocks and 1-month survival in OHCA patients.

Methods: We conducted a prospective observational study using national registry data obtained from patients with OHCA between January 1, 2009 and December 31, 2012 in Japan. The study subjects were ≥ 18-110 years of age, had suffered from an OHCA before arrival of EMS personnel, had a witnessed collapse, had an initial rhythm that was shockable [VF/ventricular tachycardia (pulseless VT)], were not delivered a shock using a public automated external defibrillator (AED), received one or more shocks using a biphasic defibrillator by EMS personnel, and were transported to a medical institution between January 1, 2009 and December 31, 2012. There were 20,851 OHCA cases which met the inclusion criteria during the study period. Signal detection analysis was used to identify the cutoff point in the number of prehospital defibrillation shocks most closely related to one-month survival. Variables related to the number of defibrillations or one-month survival in OHCA were identified using multiple logistic regression analysis.

Results: A cutoff point in the number of pre-hospital defibrillation shocks most closely associated with 1-month OHCA survival was between two and three (χ(2) = 209.61, p < 0.0001). Among those patients who received two shocks or less, 34.48% survived for at least 1 month, compared with 24.75% of those who received three shocks or more. The number of defibrillations (odds ratio [OR] = 1.19, 95% CI: 1.03, 1.38), OHCA origin (OR = 2.81, 95% CI: 2.26, 3.49), use of ALS devices (OR = 0.68, 95% CI: 0.59, 0.79), use of epinephrine (OR = 0.33, 95% C: 0.28, 0.39), interval between first defibrillation and first ROSC (OR = 1.45, 95% CI: 1.18, 1.78), and chest compression (OR = 1.21, 95% CI: 1.06, 1.38) were associated significantly with 1-month OCHA survival.

Conclusions: The cutoff point in the number of defibrillations of patients with OHCA most closely related to one-month survival was between 2 and 3, and the likelihood of non-survival 1 month after an OHCA was increased when ≥3 shocks were needed. Further studies are needed to verify this finding.

No MeSH data available.


Related in: MedlinePlus