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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

Optimal cutoff time point from the call until arrival at the hospital, which was the best predictor of 1-month survival. The 1-month survival rate and mean number of defibrillation shocks in the two groups divided by the signal detection analysis are also shown.
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Fig4: Optimal cutoff time point from the call until arrival at the hospital, which was the best predictor of 1-month survival. The 1-month survival rate and mean number of defibrillation shocks in the two groups divided by the signal detection analysis are also shown.

Mentions: The time from call until arrival at the hospital was another predictor of 1-month survival in patients with an OHCA. Thus, the cutoff point in the time from the call and arrival at hospital most closely related to 1-month survival was identified by survey documentation and analysis (SDA; Table 3). A total of 47 values were used to represent the time between the call and arrival at the hospital, and the cut-off value was forwarded by one. Although χ2 for 40 values was significant (all p < 0.05), the largest value for χ2 was between 26 and 27 minutes (χ2 = 279.53, p < 0.0001). Patients were divided into two groups: ≤ 26 minutes (group 1) and ≥ 27 minutes (group 2) based on the time elapsed from the call until arrival at the hospital. The 1-month survival rate and the mean number of shocks were 38.87% and 2.02 (±1.23), respectively, in the ≤ 26 min group and 27.3% and 2.52 (±1.81), respectively, in the ≥ 27 min group (Figure 4). The mean number of shocks in the ≤ 26 min group was very close to two (i.e., 2.02).Table 3


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)

Optimal cutoff time point from the call until arrival at the hospital, which was the best predictor of 1-month survival. The 1-month survival rate and mean number of defibrillation shocks in the two groups divided by the signal detection analysis are also shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Optimal cutoff time point from the call until arrival at the hospital, which was the best predictor of 1-month survival. The 1-month survival rate and mean number of defibrillation shocks in the two groups divided by the signal detection analysis are also shown.
Mentions: The time from call until arrival at the hospital was another predictor of 1-month survival in patients with an OHCA. Thus, the cutoff point in the time from the call and arrival at hospital most closely related to 1-month survival was identified by survey documentation and analysis (SDA; Table 3). A total of 47 values were used to represent the time between the call and arrival at the hospital, and the cut-off value was forwarded by one. Although χ2 for 40 values was significant (all p < 0.05), the largest value for χ2 was between 26 and 27 minutes (χ2 = 279.53, p < 0.0001). Patients were divided into two groups: ≤ 26 minutes (group 1) and ≥ 27 minutes (group 2) based on the time elapsed from the call until arrival at the hospital. The 1-month survival rate and the mean number of shocks were 38.87% and 2.02 (±1.23), respectively, in the ≤ 26 min group and 27.3% and 2.52 (±1.81), respectively, in the ≥ 27 min group (Figure 4). The mean number of shocks in the ≤ 26 min group was very close to two (i.e., 2.02).Table 3

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