scholarly journals AED applied, not recommending defibrillation - A validation study of the new variable “AED” in the Danish Cardiac Arrest Registry

2021 ◽  
Author(s):  
Eleonora Casarini ◽  
Tazha Ako ◽  
Kristian Bundgaard Ringgren ◽  
Stig Nikolaj Fasmer Blomberg ◽  
Helle Collatz Christensen
Keyword(s):  
Cardiac Arrest ◽  
Validation Study ◽  
Epidemiological Studies ◽  
Spontaneous Circulation ◽  
Electrical Shock ◽  
Direct Current Cardioversion ◽  
Substantial Resource ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Service Response Time ◽  
Utstein Style

Abstract Background: to design and implement a new variable, in accordance with the Utstein style – namely the variable “AED” - considering the challenges of reporting cases in which the AED did not recommend an electrical shock after analyzing cardiac arrhythmias, for use in the Danish Cardiac Arrest Registry.Participants: Patients with out-of-hospital cardiac arrest for which resuscitation was attempted between 2016 and 2019, identified in the nationwide Danish Cardiac Arrest Registry. Their medical records were reviewed to establish a positive variable in “AED”.Methods: Data from the national Danish Cardiac Arrest Registry were used to identify core features of out-of-hospital cardiac arrests medical recording in Denmark and its possible improvement. Results: Among n= 1080 cases, summary statistics on core recording variables of interest were collected. We found statistically significant differences in the two cohorts of cardiac arrests where an AED was present on the scene and recorded in the Danish Cardiac Arrest Registry, regarding age, location, emeregency medical service response time, witnesses, bystander cardiopulmonary resuscitation, first monitored rhythm, direct current cardioversion shock delivered by the medical staff and survival outcomes such as return of spontaneous circulation at any time, status at arrival at hospital and 30-day survival. Conclusions: This validation study showed an improved completeness of registration of out-of-hospital cardiac arrests when implementing the new AED-variable, in accordance with the Utstein style. Thus, the new AED-variable is a valid and substantial resource for future epidemiological studies. However, a future effort to improve registration completeness along with continuous improvement of the Danish Cardiac Arrest Registry is needed.

scholarly journals The Effect of Implementing Mechanical Cardiopulmonary Resuscitation Devices on Out-of-Hospital Cardiac Arrest Patients in an Urban City of Taiwan

2021 ◽  
Vol 18 (7) ◽  
pp. 3636
Author(s):  
Yi-Rong Chen ◽  
Chi-Jiang Liao ◽  
Han-Chun Huang ◽  
Cheng-Han Tsai ◽  
Yao-Sing Su ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Primary Outcome ◽  
Medical Service ◽  
Spontaneous Circulation ◽  
High Quality ◽  
Urban City ◽  
Service Response Time ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest

High-quality cardiopulmonary resuscitation (CPR) is a key element in out-of-hospital cardiac arrest (OHCA) resuscitation. Mechanical CPR devices have been developed to provide uninterrupted and high-quality CPR. Although human studies have shown controversial results in favor of mechanical CPR devices, their application in pre-hospital settings continues to increase. There remains scant data on the pre-hospital use of mechanical CPR devices in Asia. Therefore, we conducted a retrospective cohort study between September 2018 and August 2020 in an urban city of Taiwan to analyze the effects of mechanical CPR devices on the outcomes of OHCA; the primary outcome was attainment of return of spontaneous circulation (ROSC). Of 552 patients with OHCA, 279 received mechanical CPR and 273 received manual CPR, before being transferred to the hospital. After multivariate adjustment for the influencing factors, mechanical CPR was independently associated with achievement of any ROSC (OR = 1.871; 95%CI:1.195–2.930) and sustained (≥24 h) ROSC (OR = 2.353; 95%CI:1.427–3.879). Subgroup analyses demonstrated that mechanical CPR is beneficial in shorter emergency medical service response time (≤4 min), witnessed cardiac arrest, and non-shockable cardiac rhythm. These findings support the importance of early EMS activation and high-quality CPR in OHCA resuscitation.

scholarly journals The influence of past experiences on future willingness to perform bystander cardiopulmonary resuscitation

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Keng Sheng Chew ◽  
Shazrina Ahmad Razali ◽  
Shirly Siew Ling Wong ◽  
Aisyah Azizul ◽  
Nurul Faizah Ismail ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Hospital Setting ◽  
Spontaneous Circulation ◽  
Cardiac Events ◽  
Validated Questionnaire ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Past Experiences ◽  
Hospital Cardiac Arrest

Abstract Background The influence of past familial experiences of receiving cardiopulmonary resuscitation (CPR) and medical help in various cardiac arrest and nonfatal cardiac events toward willingness to “pay it forward” by helping the next cardiac arrest victim was explored. Methods Using a validated questionnaire, 6248 participants were asked to rate their willingness to perform bystander chest compression with mouth-to-mouth ventilation and chest compression-only CPR. Their past familial experiences of receiving cardiopulmonary resuscitation (CPR) and medical help in various cardiac arrest and nonfatal cardiac events were also recorded. Results Kruskal-Wallis test with post hoc Dunn’s pairwise comparisons showed that the following were significantly more willing to perform CPR with mouth-to-mouth ventilation: familial experience of “nonfatal cardiac events” (mean rank = 447) vs “out-of-hospital cardiac arrest with no CPR” (mean rank = 177), U = 35442.5, z = −2.055, p = 0.04; “in-hospital cardiac arrest and successful CPR” (mean rank = 2955.79) vs “none of these experiences” (mean rank = 2468.38), U = 111903, z = −2.60, p = 0.01; and “in-hospital cardiac arrest with successful CPR” (mean rank = 133.45) vs “out-of-hospital arrest with no CPR” (mean rank = 112.36), U = 4135.5, z = −2.06, p = 0.04. For compression-only CPR, Kruskal-Wallis test with multiple runs of Mann-Whitney U tests showed that “nonfatal cardiac events” group was statistically higher than the group with “none of these experiences” (mean rank = 3061.43 vs 2859.91), U = 1194658, z = −2.588, p = 0.01. The groups of “in-hospital cardiac arrest with successful CPR” and “in-hospital cardiac arrest with transient return of spontaneous circulation” were the most willing groups to perform compression-only CPR. Conclusion Prior familial experiences of receiving CPR and medical help, particularly among those with successful outcomes in a hospital setting, seem to increase the willingness to perform bystander CPR.

End-Tidal CO2 as a Predictor of Survival in Out-of-Hospital Cardiac Arrest

2011 ◽  
Vol 26 (3) ◽  
pp. 148-150 ◽  
Author(s):  
Marc Eckstein ◽  
Lorien Hatch ◽  
Jennifer Malleck ◽  
Christian McClung ◽  
Sean O. Henderson
Keyword(s):  
Cardiac Arrest ◽  
Los Angeles ◽  
Spontaneous Circulation ◽  
Outcome Variable ◽  
Primary Outcome Variable ◽  
Return Of Spontaneous Circulation ◽  
Bystander Cardiopulmonary Resuscitation ◽  
The Mean ◽  
End Tidal ◽  
Hospital Cardiac Arrest

AbstractObjective: The objective of this study was to evaluate initial end-tidal CO2 (EtCO2) as a predictor of survival in out-of-hospital cardiac arrest.Methods: This was a retrospective study of all adult, non-traumatic, out-of-hospital, cardiac arrests during 2006 and 2007 in Los Angeles, California. The primary outcome variable was attaining return of spontaneous circulation (ROSC) in the field. All demographic information was reviewed and logistic regression analysis was performed to determine which variables of the cardiac arrest were significantly associated with ROSC.Results: There were 3,121 cardiac arrests included in the study, of which 1,689 (54.4%) were witnessed, and 516 (16.9%) were primary ventricular fibrillation (VF). The mean initial EtCO2 was 18.7 (95%CI = 18.2–19.3) for all patients. Return of spontaneous circulation was achieved in 695 patients (22.4%) for which the mean initial EtCO2 was 27.6 (95%CI = 26.3–29.0). For patients who failed to achieve ROSC, the mean EtCO2 was 16.0 (95%CI = 15.5–16.5). The following variables were significantly associated with achieving ROSC: witnessed arrest (OR = 1.51; 95%CI = 1.07–2.12); initial EtCO2 >10 (OR = 4.79; 95%CI = 3.10–4.42); and EtCO2 dropping <25% during the resuscitation (OR = 2.82; 95%CI = 2.01–3.97).The combination of male gender, lack of bystander cardiopulmonary resuscitation, unwitnessed collapse, non-vfib arrest, initial EtCO2 ≤10 and EtCO2 falling > 25% was 97% predictive of failure to achieve ROSC.Conclusions: An initial EtCO2 >10 and the absence of a falling EtCO2 >25% from baseline were significantly associated with achieving ROSC in out-of-hospital cardiac arrest. These additional variables should be incorporated in termination of resuscitation algorithms in the prehospital setting.

Resuscitation for Patients with Out-of-Hospital Cardiac Arrest: Singapore

2002 ◽  
Vol 17 (2) ◽  
pp. 96-101 ◽  
Author(s):  
Ghee Hian Lim ◽  
Eillyne Seow
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Hospital Setting ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Very High Frequency ◽  
Traumatic Cardiac Arrest ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest ◽  
Very High

AbstractAim:To evaluate characteristics and outcome of out-of-hospital cardiac arrest (OHCA) patients presenting to the Emergency Department (ED), and to examine factors that could be used to determine to prolong or abort resuscitation for these patients.Method:All OHCA patients presenting to the ED were studied over a three-month period from November 2001 through January 2002. Patient with traumatic cardiac arrest were excluded. Data were collected from the ambulance case records, ED resuscitation charts, and the ED Very High Frequency (VHF) radio case-log sheet. Information collected included the patient's demographic characteristics, timings (time from call to ambulance arrival on scene, time from arrival at scene to departure from scene, time from scene to arrival in the ED) recorded in the pre-hospital setting, the outcome of the resuscitation, and the final outcome for patients who survived ED resuscitation.Results:Ninety-three non-traumatic patients with an OHCA were studied during the three-month period. Of the 93 patients, 15 (16.1%) survived ED resuscitation, and one survived to hospital discharge. There were no statistically significant differences for age, race, or gender with regards to the outcome of the resuscitation. The initial cardiac rhythms were asystole (65), pulseless electrical activity (21), and ventricular fibrillation (7). Fourteen (15%) received bystander cardiopulmonary resuscitation (CPR). All seven patients with return of spontaneous circulation (ROSC) on arrival in the ED survived ED resuscitation. The ambulance took an average of 11.80 ±3.36 minutes for the survivors and 11.8 ±4.22 minutes for the non-survivors from the time of call to get to these patients. The average of the scene times was 12.5 ±4.61 minutes for the survivors and 12.0 ±4.02 minutes for the non-survivors. Transport time from the scene to the ED took an average of 39.1 ±8.32 minutes for the survivors and 37.2 ±9.00 minutes for the non-survivors.Conclusion:The survival rate for patients with OHCA after ED resuscitation is similar to the results from other studies. There is a need to increase the awareness and delivery of basic life support by public education. Automatic External Defibrillators (AED) should be available widely to ensure that the chance of early defibrillation is increased. Prolonged resuscitation efforts appear to be futile for OHCA patients if the time from cardiac arrest until arrival in the ED is ≥30 minutes coupled with no ROSC, and if continuous asystole has been documented for >10 minutes.

Abstract 315: Influence of Previous Comorbidities on Hospital Outcome After Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Florence Dumas ◽  
Audrey Paoli ◽  
Marine Paul ◽  
Jean-Francois Llitjos ◽  
Guillaume Savary ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Spontaneous Circulation ◽  
Multinomial Regression ◽  
Shockable Rhythm ◽  
Poor Neurological Outcome ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Comorbidity Index ◽  
Mode Of Death

Introduction: Despite improvements, overall survival after out-of-hospital cardiac arrest (OHCA) remains low, even in those with return of spontaneous circulation (ROSC). In addition to usual prognostic characteristics, patients’ medical history may also influence the outcome. This study aimed to investigate the role of comorbidities on hospital mortality, neurological outcome and mode of death in OHCA patients with successful ROSC. Methods: From Jan 2012 to Sep 2017, all consecutive non-traumatic OHCA adults with stable ROSC admitted in ICU were included. Utstein characteristics, circumstances and in-hospital interventions were prospectively recorded. Comorbidities were measured using Charlson Comorbidity Index (CCI), divided into 3 groups (CCI=0,CCI=1-3,CCI>3).The influence of CCI on mortality and poor neurological outcome at discharge (with a Cerebral Performance Categories level>2) was assessed using logistic regression and association with mode of death (withdrawal of life sustaining treatments (WLST) or other causes) using multinomial regression. Results: During the study period, among 777 patients admitted alive and analyzed, 504 (65%) pts were discharged as CPC>2 and 484 (62%) died in ICU with 48%, 61% and 70% in CCI-0, CCI 1-3 and CCI>3 respectively. After adjustment, an increase in CCI was associated with poor neurological outcome (ORadj 2.22 [1.21-4.08] for CCI=1-3 and ORadj=2.86 [1.50-5.45] for CCI>3; ref CCI=0). Other independent predictors were an initial non shockable rhythm (OR=3.70[2.38-5.88]), absence of bystander cardiopulmonary resuscitation (CPR) (OR=1.96[1.20-3.22]), higher dose of epinephrine (OR= 5.88 [3.70-9.09]), longer resuscitation (CA-CPR, OR=1.69 [1.10-2.63] and CPR-ROSC, OR=2.43 [1.56-3.85]). Using multinomial regression, an increased CCI was associated with all modes of death, but particularly with WLST (RRadj=2.43 [1.25-4.71] for CCI=1-3 and 4.27[2.15-8.48] for CCI>3, ref CCI=0). Conclusion: A high number of comorbidities, as assessed by CCI, was associated with a worse neurological and a higher mortality in patients admitted alive after cardiac arrest. Presence and burden of comorbidities should be considered in the evaluation of the prognosis in patients admitted after cardiac arrest

Abstract 18304: Are Prolonged Resuscitation Efforts Worthwhile? Patient Outcomes by Time to Restoration of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kristian Kragholm ◽  
Monique Anderson ◽  
Carolina Malta Hansen ◽  
Phillip J. Schulte ◽  
Michael C. Kurz ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Survival Rates ◽  
Spontaneous Circulation ◽  
Significant Survival ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Bystander Cpr ◽  
Using Data ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Introduction: How long resuscitation attempts should be continued before termination of efforts is not clear in patients with out-of-hospital cardiac arrest (OHCA). We studied outcomes in patients with return of spontaneous circulation (ROSC) across quartiles of time from 9-1-1 call to ROSC. Hypothesis: Survival with favorable neurological outcome is seen in all time intervals from 9-1-1 call to ROSC. Methods: Using data from Resuscitation Outcomes Consortium (ROC) Prehospital Resuscitation clinical trials: IMpedance valve and an Early vs. Delayed analysis (PRIMED) available via National Institute of Health, patients with ROSC not witnessed by the emergency medical service (EMS) were identified and grouped by quartiles of time from 9-1-1 call to ROSC. We defined favorable neurological outcome as modified Rankin Scale (mRS) scores of ≤3. Results: Included were 3,431 OHCA patients with ROSC. Median time from 9-1-1 call to ROSC was 22.8 min (25%-75% 17 min–29.2 min); 953 (27.8%) survived to discharge (20.4% mRS ≤3). Significant survival and favorable neurological outcome were seen in each quartile (Figure). In patients who received bystander cardiopulmonary resuscitation (CPR), survival rates were 60.9%, 33.2%, 18.3% and 11.1% across quartiles of time to ROSC versus (vs.) 51.5%, 25.6%, 13.3% and 8.9% in patients without bystander CPR; corresponding rates of favorable neurological outcome were 50.7%, 23.8%, 12.2% and 9.1% vs. 40.1%, 16.6%, 8% and 4.8%. Correspondingly, survival rates in defibrillated patients were 70.1%, 45.9%, 25.5% and 16.4% vs. 36.3%, 9.5%, 6% and 3.4% in non-defibrillated patients; corresponding rates of favorable neurological outcome were 59.8%, 33.4%, 18.3% and 11.4% vs. 24.4%, 4.1%, 1.9% and 1.8%. Conclusions: Survival with favorable neurological outcome was seen in all quartiles of time to ROSC, even in cases without bystander CPR or shocks delivered. This suggests that EMS personnel should not terminate resuscitation efforts too early.

scholarly journals Survival of patients with and without diabetes following out-of-hospital cardiac arrest: A nationwide Danish study

2019 ◽  
Vol 9 (6) ◽  
pp. 599-607 ◽  
Author(s):  
Grímur Høgnason Mohr ◽  
Kathrine B Søndergaard ◽  
Jannik L Pallisgaard ◽  
Sidsel Gamborg Møller ◽  
Mads Wissenberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Heart Rhythm ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Significant Difference ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest ◽  
Diabetes Patients

Background: Research regarding out-of-hospital cardiac arrest (OHCA) survival of diabetes patients is sparse and it remains unknown whether initiatives to increase OHCA survival benefit diabetes and non-diabetes patients equally. We therefore examined overall and temporal survival in diabetes and non-diabetes patients following OHCA. Methods: Adult presumed cardiac-caused OHCAs were identified from the Danish Cardiac Arrest Registry (2001–2014). Associations between diabetes and return of spontaneous circulation upon hospital arrival and 30-day survival were estimated with logistic regression adjusted for patient- and OHCA-related characteristics. Results: In total, 28,955 OHCAs were included of which 4276 (14.8%) had diabetes. Compared with non-diabetes patients, diabetes patients had more comorbidities, same prevalence of bystander-witnessed arrests (51.7% vs. 52.7%) and bystander cardiopulmonary resuscitation (43.2% vs. 42.0%), more arrests in residential locations (77.3% vs. 73.0%) and were less likely to have shockable heart rhythm (23.5% vs. 27.9%). Temporal increases in return of spontaneous circulation and 30-day survival were seen for both groups (return of spontaneous circulation: 8.8% in 2001 to 22.3% in 2014 (diabetes patients) vs. 7.8% in 2001 to 25.7% in 2014 (non-diabetes patients); and 30-day survival: 2.8% in 2001 to 9.7% in 2014 vs. 3.5% to 14.8% in 2014, respectively). In adjusted models, diabetes was associated with decreased odds of return of spontaneous circulation (odds ratio 0.74 (95% confidence interval 0.66–0.82)) and 30-day survival (odds ratio 0.56 (95% confidence interval 0.48–0.65)) (interaction with calendar year p=0.434 and p=0.243, respectively). Conclusion: No significant difference in temporal survival was found between the two groups. However, diabetes was associated with lower odds of return of spontaneous circulation and 30-day survival.

scholarly journals Does location matter? A proposed methodology to evaluate neighbourhood effects on cardiac arrest survival and bystander CPR

CJEM ◽  
2015 ◽  
Vol 17 (3) ◽  
pp. 286-294 ◽  
Author(s):  
Jason E. Buick ◽  
Katherine S. Allan ◽  
Joel G. Ray ◽  
Alexander Kiss ◽  
Paul Dorian ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Educational Interventions ◽  
Population Based ◽  
Spontaneous Circulation ◽  
Operating Characteristics ◽  
Cohort Study Design ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Awareness Programs ◽  
Observational Cohort ◽  
Neighbourhood Characteristics

AbstractBackgroundTraditional variables used to explain survival following out-of-hospital cardiac arrest (OHCA) account for only 72% of survival, suggesting that other unknown factors may influence outcomes. Research on other diseases suggests that neighbourhood factors may partly determine health outcomes. Yet, this approach has rarely been used for OHCA. This work outlines a methodology to investigate multiple neighbourhood factors as determinants of OHCA outcomes.MethodsA retrospective, observational cohort study design will be used. All adult non-emergency medical service witnessed OHCAs of cardiac etiology within the city of Toronto between 2006 and 2010 will be included. Event details will be extracted from the Toronto site of the Resuscitation Outcomes Consortium Epistry—Cardiac Arrest, an existing population-based dataset of consecutive OHCA patients. Geographic information systems technology will be used to assign patients to census tracts. Neighbourhood variables to be explored include the Ontario Marginalization Index (deprivation, dependency, ethnicity, and instability), crime rate, and density of family physicians. Hierarchical logistic regression analysis will be used to explore the association between neighbourhood characteristics and 1) survival-to-hospital discharge, 2) return-of-spontaneous circulation at hospital arrival, and 3) provision of bystander cardiopulmonary resuscitation (CPR). Receiver operating characteristics curves will evaluate each model’s ability to discriminate between those with and without each outcome.DiscussionThis study will determine the role of neighbourhood characteristics in OHCA and their association with clinical outcomes. The results can be used as the basis to focus on specific neighbourhoods for facilitating educational interventions, CPR awareness programs, and higher utilization of automatic defibrillation devices.

scholarly journals Prognostic value of changes in the cardiac arrest rhythms from the prehospital stage to the emergency department in out-of-hospital cardiac arrest patients without prehospital returns of spontaneous circulation: A nationwide observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257883
Author(s):  
Jae Guk Kim ◽  
Hyungoo Shin ◽  
Jun Hwi Cho ◽  
Hyun Young Choi ◽  
Wonhee Kim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Propensity Score ◽  
Hospital Discharge ◽  
Prognostic Value ◽  
Spontaneous Circulation ◽  
Shock Group ◽  
Electrical Shock ◽  
Neurological Outcomes ◽  
Hospital Cardiac Arrest

Background This study aimed to assess the prognostic value of the changes in cardiac arrest rhythms from the prehospital stage to the ED (emergency department) in out-of-hospital cardiac arrest (OHCA) patients without prehospital returns of spontaneous circulation (ROSC). Methods This retrospective analysis was performed using nationwide population-based OHCA data from South Korea between 2012 and 2016. Patients with OHCA with medical causes and without prehospital ROSC were included and divided into four groups according to the nature of their cardiac arrest rhythms (shockable or non-shockable) in the prehospital stage and in the ED: (1) the shockable and shockable (Shock-Shock) group, (2) the shockable and non-shockable (Shock-NShock) group, (3) the non-shockable and shockable (NShock-Shock) group, and (4) the non-shockable and non-shockable (NShock-NShock) group. The presence of a shockable rhythm was confirmed based on the delivery of an electrical shock. Propensity score matching and multivariate logistic regression analyses were used to assess the effect of changes in the cardiac rhythms on patient outcomes. The primary outcome was sustained ROSC in the ED; the secondary outcomes were survival to hospital discharge and good neurological outcomes at hospital discharge. Results After applying the exclusion criteria, 51,060 eligible patients were included in the study (Shock-Shock, 4223; Shock-NShock, 3060; NShock-Shock, 11,509; NShock-NShock, 32,268). The propensity score-matched data were extracted from the six comparative subgroups. For sustained ROSC in the ED, Shock-Shock showed a higher likelihood than Shock-NShock (P <0.01) and NShock-NShock (P <0.01), Shock-NShock showed a lower likelihood than NShock-Shock (P <0.01) and NShock-NShock (P <0.01), NShock-Shock showed a higher likelihood NShock-NShock (P <0.01). For survival to hospital discharge, Shock-Shock showed a higher likelihood than Shock-NShock (P <0.01), NShock-Shock (P <0.01), and NShock-NShock (P <0.01), Shock-NShock showed a higher likelihood than NShock-Shock (P <0.01) and NShock-NShock (P <0.01), of sustained ROSC in the ED. For good neurological outcomes, Shock-Shock showed higher likelihood than Shock-NShock (P <0.01), NShock-Shock (P <0.01), and NShock-NShock (P <0.01), Shock-NShock showed better likelihood than NShock-NShock (P <0.01), NShock-Shock showed a better likelihood than NShock-NShock (P <0.01). Conclusion Sustained ROSC in the ED may be expected for patients with shockable rhythms in the ED compared with those with non-shockable rhythms in the ED. For the clinical outcomes, survival to hospital discharge and neurological outcomes, patients with Shock-Shock showed the best outcome, whereas patients with NShock-NShock showed the poorest outcome and Shock-NShock showed a higher likelihood of achieving survival to hospital discharge with no significant differences in the neurological outcomes compared with NShock-Shock.

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