Katzenschlager Stephan, Kaltschmidt Nikolai, Orlob Simon, Weilbacher Frank, Huck Matthias, Seewald Stephan, Rück Lisa, Hoffmann Hanna, Popp Erik, Gräsner Jan-Thorsten, Wnent Jan
Heidelberg University, Medical Faculty Heidelberg, Department of Anaesthesiology, Heidelberg, Germany.
Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany.
Resusc Plus. 2025 Jul 5;25:101022. doi: 10.1016/j.resplu.2025.101022. eCollection 2025 Sep.
This study examined defibrillation attempts during out-of-hospital cardiac arrest (OHCA) with shockable rhythm and survival outcomes, focusing on good neurological outcome at discharge. It aimed to identify predictors of favorable outcomes and guide future trials for alternative defibrillation strategies.
In this retrospective, multicenter cohort study, data were extracted from the German Resuscitation Registry for adult patients (≥18 years) who experienced OHCA with an initial shockable rhythm between January 2007 and December 2023. Only cases from good data quality centers were included. Patients were categorized according to the number of defibrillations received (1, 2-3, 4-6, and ≥7). Multivariable logistic regression was performed to identify independent predictors of favorable neurological outcomes.
Out of 332,001 OHCA records, 15,284 met the inclusion criteria. Survival endpoints, including any return of spontaneous circulation, hospital admission with ROSC, 24-h survival, and survival to discharge, significantly declined with an increasing number of defibrillation attempts. In the regression analysis, EMS-witnessed arrests were strongly associated with favorable outcomes (OR 3.8; 95 % Confidence Interval 3.1-4.7). More defibrillations, prolonged ambulance response times, and older age were independently associated with lower odds of achieving a favorable neurological outcome.
An increasing number of defibrillations is independently linked to reduced survival and worse neurological outcomes in adults experiencing out-of-hospital cardiac arrest with an initial shockable rhythm. These results underscore the urgent need for alternative management strategies for multiple defibrillation attempts. These compelling observations warrant a reevaluation of defibrillation protocols to improve patient outcomes.
本研究调查了院外心脏骤停（OHCA）伴有可电击心律时的除颤尝试情况及生存结局，重点关注出院时良好的神经功能结局。其目的是确定良好结局的预测因素，并为未来替代除颤策略的试验提供指导。
在这项回顾性多中心队列研究中，从德国复苏登记处提取了2007年1月至2023年12月期间经历OHCA且初始心律为可电击心律的成年患者（≥18岁）的数据。仅纳入数据质量良好中心的病例。根据接受除颤的次数（1次、2 - 3次、4 - 6次和≥7次）对患者进行分类。进行多变量逻辑回归以确定良好神经功能结局的独立预测因素。
在332,001条OHCA记录中，15,284条符合纳入标准。生存终点，包括任何自主循环恢复、入院时伴有ROSC、24小时生存及出院生存，随着除颤尝试次数的增加而显著下降。在回归分析中，急救医疗服务（EMS）见证的心脏骤停与良好结局密切相关（比值比3.8；95%置信区间3.1 - 4.7）。更多的除颤、延长的救护车响应时间和较高年龄与获得良好神经功能结局的较低几率独立相关。
在初始心律为可电击心律的院外心脏骤停成年患者中，除颤次数增加与生存率降低和神经功能结局较差独立相关。这些结果强调了针对多次除颤尝试采用替代管理策略的迫切需求。这些引人注目的观察结果值得重新评估除颤方案以改善患者结局。
