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Can a Shockable Initial Rhythm Identify Out-of-Hospital Cardiac Arrest Patients with a Short No-flow Time?
- Source :
- Resuscitation. 158
- Publication Year :
- 2020
-
Abstract
- Aims Initial shockable rhythms may be a marker of shorter duration between collapse and initiation of cardiopulmonary resuscitation, known as no-flow time (NFT), for patients suffering an out-of-hospital cardiac arrest (OHCA). Eligibility for extracorporeal resuscitation is conditional on a short NFT. Patients with an unwitnessed OHCA could be candidate for extracorporeal resuscitation despite uncertain NFT if an initial shockable rhythm is a reliable stand-in. Herein, we sought to describe the sensitivity and specificity of an initial shockable rhythm for predicting a NFT of five minutes or less. Methods Using a registry of OHCA in Montreal, Canada, adult patients who experienced a witnessed non-traumatic OHCA, but who did not receive bystander cardiopulmonary resuscitation, were included. The sensitivity and specificity of an initial shockable rhythm for predicting a NFT of five minute or less were calculated. The association between the NFT and the presence of a shockable rhythm was evaluated using a multivariable logistic regression. Results A total of 2450 patients were included, of whom 863 (35%) had an initial shockable rhythm and 1085 (44%) a NFT of five minutes or less. The sensitivity of an initial shockable rhythm to predict a NFT of five minutes or less was 36% (95% confidence interval [95%CI] 33–39), specificity was 66% (95%CI 63–68), the positive likelihood ratio was 1.05 (95%CI 0.94–1.17) and the negative likelihood ratio of 0.97 (95%CI 0.92–1.03). The probabilities of observing a shockable rhythm stayed stable up to 15 minutes, while the probabilities of observing a PEA lowered rapidly initially. Longer NFT were associated with lower odds of observing an initial shockable rhythm (adjusted odds ratio = 0.97 [95%CI 0.94–0.99], p = 0.012). Conclusions An initial shockable rhythm is a poor predictor of a short NFT, despite there being an association between the NFT and the presence of a shockable rhythm.
- Subjects :
- Adult
medicine.medical_specialty
Resuscitation
Canada
Emergency Medical Services
medicine.medical_treatment
Electric Countershock
030204 cardiovascular system & hematology
Emergency Nursing
Logistic regression
Likelihood ratios in diagnostic testing
Out of hospital cardiac arrest
03 medical and health sciences
0302 clinical medicine
Rhythm
Internal medicine
medicine
Humans
Cardiopulmonary resuscitation
Registries
business.industry
030208 emergency & critical care medicine
Confidence interval
Cardiopulmonary Resuscitation
Duration (music)
Emergency Medicine
Cardiology
Cardiology and Cardiovascular Medicine
business
Out-of-Hospital Cardiac Arrest
Subjects
Details
- ISSN :
- 18731570
- Volume :
- 158
- Database :
- OpenAIRE
- Journal :
- Resuscitation
- Accession number :
- edsair.doi.dedup.....82da6f54d8f82d4a40137fbde17aa5b3