Department of Emergency Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
Department of Emergency Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Ther Hypothermia Temp Manag. 2020 Dec;10(4):220-228. doi: 10.1089/ther.2019.0023. Epub 2019 Aug 14.
Shockable rhythm in out-of-hospital cardiac arrest (OHCA) implies better outcome and underlying coronary stenosis. We investigated the neurologic outcome and coronary lesions between initial shockable rhythm and turn-to-shockable rhythm. This multicenter, retrospective observational study included adult nontraumatic OHCA survivors with any shockable rhythm during cardiopulmonary resuscitation (CPR) who underwent targeted temperature management between January 2010 and December 2016. Patients were divided into two groups according to the first monitored rhythm: initial shockable rhythm or turn-to-shockable rhythm. The primary outcome was good neurologic outcome at discharge based on cerebral performance categories, and the secondary outcomes were survival discharge, recurrent arrest, and coronary lesions. The two groups were matched in a 1:1 ratio using propensity score (PS). Of 426 patients, 137 and 289 patients were divided into the turn-to-shockable and initial shockable rhythm groups, respectively. Overall, 224 (52.6%) patients had good neurologic outcomes. The turn-to-shockable rhythm group had less patients with good neurologic outcome (57/137 vs. 167/289; = 0.002) and less culprit lesions in the left anterior descending and left circumflex arteries. However, survival discharge and recurrent arrest were not different between the two groups, and the turn-to-shockable rhythm had no independent association with neurologic outcome (odds ratio, 1.874; 95% confidence interval, 0.909-3.863). In the PS-matched cohort, the turn-to-shockable rhythm group had similar good neurologic outcome (47/100 vs. 35/100, = 0.083). Survival discharge, recurrent arrest, and coronary culprit lesions were not different between the two groups. In this PS-matched study, OHCA with any shockable rhythm during CPR had similar neurologic outcome and coronary culprit lesions, irrespective of the first monitored rhythm.
院外心脏骤停（OHCA）中可电击节律提示更好的预后和潜在的冠状动脉狭窄。我们研究了初始可电击节律和转变为可电击节律之间的神经功能结局和冠状动脉病变。这项多中心、回顾性观察性研究纳入了 2010 年 1 月至 2016 年 12 月期间接受心肺复苏（CPR）期间任何可电击节律且接受目标温度管理的成年非创伤性 OHCA 幸存者。根据首次监测的节律，患者分为初始可电击节律或转变为可电击节律两组。主要结局为出院时根据脑功能分类的良好神经功能结局，次要结局为存活出院、再次停搏和冠状动脉病变。使用倾向评分（PS）将两组以 1:1 比例匹配。在 426 例患者中，137 例和 289 例患者分别分为转变为可电击节律和初始可电击节律组。总体而言，224 例（52.6%）患者有良好的神经功能结局。转变为可电击节律组具有更好的神经功能结局（57/137 例比 167/289 例； = 0.002）和左前降支和左回旋支动脉的罪犯病变较少。然而，两组的存活出院和再次停搏无差异，转变为可电击节律与神经功能结局无独立相关性（比值比，1.874；95%置信区间，0.909-3.863）。在 PS 匹配队列中，转变为可电击节律组具有相似的良好神经功能结局（47/100 例比 35/100 例； = 0.083）。两组的存活出院、再次停搏和冠状动脉罪犯病变无差异。在这项 PS 匹配研究中，CPR 期间任何可电击节律的 OHCA 具有相似的神经功能结局和冠状动脉罪犯病变，而与首次监测的节律无关。
