Association of initial rhythm with neurologically favorable survival in non-shockable out-of-hospital cardiac arrest without a bystander witness or bystander cardiopulmonary resuscitation.

Out-of-hospital cardiac arrest (OHCA) has a predominantly non-shockable rhythm. Non-shockable rhythm, and the absence of a bystander witness or bystander cardiopulmonary resuscitation (CPR) are associated with poor outcomes. However, the association between the type of non-shockable rhythm and outcomes is not well known. To examine the association between the initial rhythm and neurologically favorable outcomes after non-shockable OHCA without a bystander witness or bystander CPR. In a nationwide, population-based, cohort study, we analyzed 213,984 adult OHCA patients with a non-shockable rhythm who had neither a bystander witness nor bystander CPR. They were identified through the Japanese national OHCA registry data from January 1, 2005 to December 31, 2010. The primary outcome was neurologically favorable survival. Among 213,984 patients, the initial rhythm was Pulseless Electrical Activity (PEA) in 31,179 patients (14.6%) and Asystole in 182,805 patients (85.4%). The neurological outcome was more favorable in PEA than in Asystole (1.4% vs. 0.2%, p<0.0001). After adjusting for age, sex, etiology of arrest, epinephrine administration, advanced airway management, time from call to contact with patient, and calendar year, PEA was associated with an increased neurologically favorable survival rate (odds ratio 7.86; 95% confidence interval 6.81-9.07). In subgroup analysis stratified by age group (18-64, 65-84, or ≥85years), the neurologically favorable survival rate was ≥1% in PEA, even for patients aged ≥85years, but <1% in Asystole among all age groups. PEA and Asystole should not be considered to be identical to non-shockable rhythm, but rather should be clearly distinguished from each other from the perspective of quantitative medical futility.

Fukuda T ，Ohashi-Fukuda N ，Matsubara T ，Doi K ，Kitsuta Y ，Nakajima S ，Yahagi N ... -  《-》

Effectiveness of Prehospital Epinephrine Administration in Improving Long-term Outcomes of Witnessed Out-of-hospital Cardiac Arrest Patients with Initial Non-shockable Rhythms.

Tomio J ，Nakahara S ，Takahashi H ，Ichikawa M ，Nishida M ，Morimura N ，Sakamoto T ... -  《-》

Effects of prehospital epinephrine administration on neurologically intact survival in bystander-witnessed out-of-hospital cardiac arrest patients with non-shockable rhythm depend on prehospital cardiopulmonary resuscitation duration required to hospital

Funada A ，Goto Y ，Tada H ，Shimojima M ，Hayashi K ，Kawashiri MA ，Yamagishi M ... -  《-》

Prognostic significance of spontaneous shockable rhythm conversion in adult out-of-hospital cardiac arrest patients with initial non-shockable heart rhythms: A systematic review and meta-analysis.

There remains controversy over the prognostic significance of spontaneous shockable rhythm conversion in out-of-hospital cardiac arrest (OHCA) patients with initial non-shockable heart rhythms (pulseless electrical activity [PEA] or asystole). The aim of this study was to examine the association of shockable rhythm conversion with multiple OHCA outcomes, and to explore effect modifiers. A dual-reviewer search was conducted in PubMed and EMBASE databases in March 2017. Data on study design, patient characteristics, outcomes, adjusting and stratifying variables were extracted. Estimates were combined using random-effects models. Twelve studies involving 1,108,281 OHCA patients with initial non-shockable heart rhythms were identified using pre-specified eligibility criteria. Combined adjusted estimates showed that shockable rhythm conversion was associated with higher odds of pre-hospital return of spontaneous circulation (ROSC) (odds ratio [OR]=1.47, 95% confidence interval [CI] 1.40-1.55). Although shockable rhythm conversion was not associated with survival to hospital discharge (OR=1.36, 95% CI 0.77-2.38), it was associated with higher odds of one-month survival (OR=1.96, 95% CI 1.66-2.31), and one-month favourable neurological outcome (OR=2.69, 95% CI 2.00-3.62). Subgroup analyses found that shockable rhythm conversion from asystole, but not PEA, was associated with pre-hospital ROSC and survival to hospital discharge, and that earlier shockable rhythm conversions, compared to those occurring later during cardiopulmonary resuscitation, were associated with higher odds of one-month favourable neurological outcome. Shockable rhythm conversion from initial non-shockable heart rhythms was associated with better OHCA outcomes, depending on the type of initial heart rhythm, and time of rhythm conversion.

Luo S ，Zhang Y ，Zhang W ，Zheng R ，Tao J ，Xiong Y ... -  《-》

Outcomes following out-of-hospital cardiac arrest with an initial cardiac rhythm of asystole or pulseless electrical activity in Victoria, Australia.

While internationally reported survival from out-of-hospital cardiac arrest (OHCA) is improving, much of the increase is being observed in patients presenting to emergency medical services (EMS) in shockable rhythms. The purpose of this study was to assess survival and 12-month functional recovery in patients presenting to EMS in asystole or pulseless electrical activity (PEA). The Victorian Ambulance Cardiac Arrest Registry was searched for adult OHCA patients presenting in non-shockable rhythms in Victoria, Australia between 1st July 2003 and 30th June 2013. We excluded patients defibrillated prior to EMS arrival and arrests witnessed by EMS. Twelve-month quality-of-life interviews were conducted on survivors who arrested between 1st January 2010 and 31st December 2012. The main outcome measures were survival to hospital discharge and 12-month functional recovery measured by the Extended Glasgow Outcome Scale (GOSE). A total of 38,378 non-shockable OHCA attended by EMS were included, of which 88.0% were asystole and 11.6% were PEA. Of the patients receiving resuscitation, survival to hospital discharge was 1.1% for asystole and 5.9% for PEA (p<0.001), with no significant improvement observed over the 10 year study period. In survivors with 12-month follow-up data, the combined rate of death, vegetative state or lower severe disability was 66.7% (95% CI 41.0-80.0%) for asystole and 44.7% (95% CI 30.2-59.9%) for PEA. Survival outcomes following OHCA with initial rhythms of asystole or PEA did not improve over the 10-year study period. Our findings indicate high rates of death within 12 months, and unfavourable functional recovery for survivors.

Andrew E ，Nehme Z ，Lijovic M ，Bernard S ，Smith K ... -  《-》