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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

Distribution of patients with OHCA by the number of prehospital defibrillations.
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Fig2: Distribution of patients with OHCA by the number of prehospital defibrillations.

Mentions: The descriptive characteristics of the study patients with OHCA are summarized in Table 1. The mean age of the study subjects was 65.73 (±15.28) yr. Approximately 79% of the study subjects were male. Overall, 6,480 of the 20,851 OHCA cases survived for at least 1 month (31.08%). The mean number of defibrillation shocks was 2.36 (±1.67). In addition, the number of patients who need 2 or more defibrillation shocks were about 50% of all the study subjects (Figure 2).Figure 2


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)

Distribution of patients with OHCA by the number of prehospital defibrillations.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Distribution of patients with OHCA by the number of prehospital defibrillations.
Mentions: The descriptive characteristics of the study patients with OHCA are summarized in Table 1. The mean age of the study subjects was 65.73 (±15.28) yr. Approximately 79% of the study subjects were male. Overall, 6,480 of the 20,851 OHCA cases survived for at least 1 month (31.08%). The mean number of defibrillation shocks was 2.36 (±1.67). In addition, the number of patients who need 2 or more defibrillation shocks were about 50% of all the study subjects (Figure 2).Figure 2

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