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The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest
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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404114/ https://www.ncbi.nlm.nih.gov/pubmed/25928051 http://dx.doi.org/10.1186/s13049-015-0112-4 |
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author | Hasegawa, Manabu Abe, Takeru Nagata, Takashi Onozuka, Daisuke Hagihara, Akihito |
author_facet | Hasegawa, Manabu Abe, Takeru Nagata, Takashi Onozuka, Daisuke Hagihara, Akihito |
author_sort | Hasegawa, Manabu |
collection | PubMed |
description | 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13049-015-0112-4) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4404114 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-44041142015-04-21 The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest Hasegawa, Manabu Abe, Takeru Nagata, Takashi Onozuka, Daisuke Hagihara, Akihito Scand J Trauma Resusc Emerg Med Original Research 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13049-015-0112-4) contains supplementary material, which is available to authorized users. BioMed Central 2015-04-17 /pmc/articles/PMC4404114/ /pubmed/25928051 http://dx.doi.org/10.1186/s13049-015-0112-4 Text en © Hasegawa et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Original Research Hasegawa, Manabu Abe, Takeru Nagata, Takashi Onozuka, Daisuke Hagihara, Akihito The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest |
title | The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest |
title_full | The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest |
title_fullStr | The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest |
title_full_unstemmed | The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest |
title_short | The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest |
title_sort | number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404114/ https://www.ncbi.nlm.nih.gov/pubmed/25928051 http://dx.doi.org/10.1186/s13049-015-0112-4 |
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