Cargando…
Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis
This study aimed to clarify the epidemiology of out of-hospital cardiac arrest (OHCA) cases caused by hypothermia. The associations between the presence/absence of shockable initial electrocardiography rhythm, prehospital defibrillation and the outcomes of OHCA were also investigated. This study inv...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10146074/ https://www.ncbi.nlm.nih.gov/pubmed/37115090 http://dx.doi.org/10.1097/MD.0000000000033618 |
_version_ | 1785034491688910848 |
---|---|
author | Ushimoto, Tomoyuki Murasaka, Kenshi Wato, Yukihiro Inaba, Hideo |
author_facet | Ushimoto, Tomoyuki Murasaka, Kenshi Wato, Yukihiro Inaba, Hideo |
author_sort | Ushimoto, Tomoyuki |
collection | PubMed |
description | This study aimed to clarify the epidemiology of out of-hospital cardiac arrest (OHCA) cases caused by hypothermia. The associations between the presence/absence of shockable initial electrocardiography rhythm, prehospital defibrillation and the outcomes of OHCA were also investigated. This study involved the retrospective analysis of prospectively collected, nationwide, population-based data for OHCA cases caused by hypothermia. One thousand five hundred seventy-five emergency medical service (EMS)-confirmed OHCA cases with hypothermia, recorded between 2013 and 2019, were extracted from the Japanese nationwide database. The primary outcome was neurologically favorable 1-month survival, defined as cerebral performance category 1 or 2. The secondary outcome was 1-month survival. OHCA cases with hypothermia occurred more frequently in the winter. In approximately half (837) of the hypothermic OHCA cases, EMS was activated in the morning (6:00 am to 11:59 am). Shockable initial electrocardiogram rhythms were recorded in 30.8% (483/1570) of cases. prehospital defibrillation was attempted in 96.1% (464/483) of cases with shockable rhythms and 25.8% (280/1087) of cases with non-shockable initial rhythms. EMS-witnessed cases, prolonged transportation time intervals and prehospital epinephrine administration were associated with rhythm conversion in cases with non-shockable initial rhythms. Binominal logit test followed by multivariable logistic regression revealed that shockable initial rhythms were associated with better outcomes. prehospital defibrillation was not significantly associated with better outcomes, regardless of the type of initial rhythm (shockable or non-shockable). Transportation to high-level emergency hospitals was associated with better outcomes (adjusted odds ratio: 2.94, 95% confidence interval: 1.66–5.21). In hypothermic OHCA, shockable initial rhythm but not prehospital defibrillation is likely to be associated with better neurologically favorable outcomes. In addition, transport to a high-level acute care hospital may be appropriately considered despite prolonged transport. Further investigation, including core temperature data in analyses, is necessary to determine the benefit of prehospital defibrillation in hypothermic OHCA. |
format | Online Article Text |
id | pubmed-10146074 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-101460742023-04-29 Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis Ushimoto, Tomoyuki Murasaka, Kenshi Wato, Yukihiro Inaba, Hideo Medicine (Baltimore) 3900 This study aimed to clarify the epidemiology of out of-hospital cardiac arrest (OHCA) cases caused by hypothermia. The associations between the presence/absence of shockable initial electrocardiography rhythm, prehospital defibrillation and the outcomes of OHCA were also investigated. This study involved the retrospective analysis of prospectively collected, nationwide, population-based data for OHCA cases caused by hypothermia. One thousand five hundred seventy-five emergency medical service (EMS)-confirmed OHCA cases with hypothermia, recorded between 2013 and 2019, were extracted from the Japanese nationwide database. The primary outcome was neurologically favorable 1-month survival, defined as cerebral performance category 1 or 2. The secondary outcome was 1-month survival. OHCA cases with hypothermia occurred more frequently in the winter. In approximately half (837) of the hypothermic OHCA cases, EMS was activated in the morning (6:00 am to 11:59 am). Shockable initial electrocardiogram rhythms were recorded in 30.8% (483/1570) of cases. prehospital defibrillation was attempted in 96.1% (464/483) of cases with shockable rhythms and 25.8% (280/1087) of cases with non-shockable initial rhythms. EMS-witnessed cases, prolonged transportation time intervals and prehospital epinephrine administration were associated with rhythm conversion in cases with non-shockable initial rhythms. Binominal logit test followed by multivariable logistic regression revealed that shockable initial rhythms were associated with better outcomes. prehospital defibrillation was not significantly associated with better outcomes, regardless of the type of initial rhythm (shockable or non-shockable). Transportation to high-level emergency hospitals was associated with better outcomes (adjusted odds ratio: 2.94, 95% confidence interval: 1.66–5.21). In hypothermic OHCA, shockable initial rhythm but not prehospital defibrillation is likely to be associated with better neurologically favorable outcomes. In addition, transport to a high-level acute care hospital may be appropriately considered despite prolonged transport. Further investigation, including core temperature data in analyses, is necessary to determine the benefit of prehospital defibrillation in hypothermic OHCA. Lippincott Williams & Wilkins 2023-04-25 /pmc/articles/PMC10146074/ /pubmed/37115090 http://dx.doi.org/10.1097/MD.0000000000033618 Text en Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | 3900 Ushimoto, Tomoyuki Murasaka, Kenshi Wato, Yukihiro Inaba, Hideo Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis |
title | Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis |
title_full | Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis |
title_fullStr | Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis |
title_full_unstemmed | Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis |
title_short | Associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: A nationwide observational study with epidemiological analysis |
title_sort | associations between prehospital defibrillation and outcomes of out-of-hospital cardiac arrests presumed to be caused by hypothermia: a nationwide observational study with epidemiological analysis |
topic | 3900 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10146074/ https://www.ncbi.nlm.nih.gov/pubmed/37115090 http://dx.doi.org/10.1097/MD.0000000000033618 |
work_keys_str_mv | AT ushimototomoyuki associationsbetweenprehospitaldefibrillationandoutcomesofoutofhospitalcardiacarrestspresumedtobecausedbyhypothermiaanationwideobservationalstudywithepidemiologicalanalysis AT murasakakenshi associationsbetweenprehospitaldefibrillationandoutcomesofoutofhospitalcardiacarrestspresumedtobecausedbyhypothermiaanationwideobservationalstudywithepidemiologicalanalysis AT watoyukihiro associationsbetweenprehospitaldefibrillationandoutcomesofoutofhospitalcardiacarrestspresumedtobecausedbyhypothermiaanationwideobservationalstudywithepidemiologicalanalysis AT inabahideo associationsbetweenprehospitaldefibrillationandoutcomesofoutofhospitalcardiacarrestspresumedtobecausedbyhypothermiaanationwideobservationalstudywithepidemiologicalanalysis |