scholarly journals Use, Outcomes and Policy on the Placement of Automated External Defibrillators on Commercial Aircraft for the Management of In-flight Cardiac Arrest; A Scoping Review

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Patrick Sheehan ◽  
Tom Quinn
Keyword(s):  
Cardiac Arrest ◽  
Scoping Review ◽  
Extraction Methods ◽  
Commercial Aircraft ◽  
Public Places ◽  
Shock Delivery ◽  
Automated External Defibrillators ◽  
Shockable Rhythm ◽  
Online Databases ◽  
International Policies

<p><strong>ABSTRACT</strong></p><p><strong>Introduction </strong></p><p>Automated external defibrillators (AEDs) are increasingly available in public places for the treatment of cardiac arrest. Some commercial aircraft carry an AED, but little is known about international policies and requirements. The aim is to review policy regarding AED placement on commercial aircraft, summarising reported incidence and outcomes of AED utilisation for individuals experiencing an in-flight cardiac arrest (IFCA).</p><p><strong>Methods</strong></p><p>A scoping review was undertaken. Online databases (Medline and CINAHL) were searched using prespecified terms to identify reports evidencing use, outcome and policy of AEDS for IFCA on commercial aircraft. Reports were screened and data extracted following scoping review extraction methods. Data were analysed to describe incidence of AED use and outcomes following IFCA, and policies regarding AED placement on commercial aircraft.</p><p><strong>Results</strong>  </p><p>9 observational studies were identified. 8 reported instances of successful shock delivery using AED. No published reports of safety incidents involving in-flight AED use were found. 7 studies reported survival following AED use: of these, 6 reported administration of a shock for IFCA survivors, whilst 1 study reported deployment of an AED without shock delivery.  Overall, survival following in-flight AED use was 9%, with 37% survival reported where patients presented with shockable rhythm. Only one policy mandating AED placement on commercial aircraft was identified.</p><p><strong>Conclusion</strong></p><p>Despite the small, retrospective and observational nature of the reports identified, findings suggest in-flight AED use is feasible and associated with improved outcomes from IFCA.</p><p><strong>Keywords:</strong> cardiac arrest; defibrillators; AED; aircraft; flight </p>

Abstract 1812: More CPR with the New Guidelines. Does it Impact VF Termination by Defibrillation Shocks?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Olivier Hersan ◽  
Daniel Jost ◽  
Isabelle L Banville ◽  
Franck Calamai ◽  
David Fontaine ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Study Protocol ◽  
Statistical Power ◽  
Study Groups ◽  
Shock Delivery ◽  
Treatment Protocols ◽  
Termination Rate ◽  
Shockable Rhythm ◽  
Resuscitation Guidelines ◽  
New Guidelines

The 2005 resuscitation Guidelines emphasize reducing interruptions of cardiopulmonary resuscitation (CPR) and provide changes to the CPR and defibrillation protocols for automated external defibrillator (AED) use. We investigated whether the differences between Guidelines 2000 and 2005 resuscitation protocols influence the ventricular fibrillation (VF) termination rate of AED shocks during out-of-hospital cardiac arrest. Methods: As part of a clinical trial, VF cardiac arrest patients treated by firefighters were prospectively randomized to treatment protocols consistent with Guidelines 2000 (CONTROL) or Guidelines 2005 (STUDY). The STUDY protocol removed stacked shocks and post-shock pulse checks. It featured 1 minute of CPR before the 1st shock, and CPR between rhythm analysis and shock delivery. All AEDs delivered escalating biphasic shocks beginning at 200J. We reviewed AED electronic records to evaluate VF termination for all shocks within the first 8 minutes of treatment. Successful defibrillation was defined per Guidelines 2005 as termination of VF for > 5seconds. A sample size of 400 shocks per group was prospectively chosen for statistical power to detect an 8% difference in VF termination rate. Results: As expected, the STUDY protocol resulted in more prompted CPR time, more actual CPR delivered, and fewer shocks during the first 8 minutes of treatment. The VF termination rate did not differ between the two groups (85% CONTROL vs. 87% STUDY). The proportions of patients with ventricular complexes (24% vs. 27%), in asystole (61% vs. 60%), or remaining in a shockable rhythm (15% vs. 13%) at 5 seconds were also not different between the CONTROL and STUDY groups, respectively. Conclusion: Despite a reduction in CPR hands-off time, VF termination effectiveness of biphasic shocks is similar for Guidelines 2000 and Guidelines 2005 cardiac arrest treatment protocols.

Abstract 12258: Out-of-hospital Cardiac Arrest With Initially Shockable Rhythm: What Are the Outcomes if No Shock is Given?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yan Xiong ◽  
Ahamed H Idris
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Shock Delivery ◽  
Return Of Spontaneous Circulation ◽  
Shockable Rhythm ◽  
Multiple Variable ◽  
Multiple Variable Regression ◽  
Hospital Cardiac Arrest ◽  
Resuscitation Attempt

Background: Prompt defibrillation is critical for termination of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in out-of-hospital cardiac arrest (OHCA). For ethical reasons, the real impact of not shocking OHCA patients with a shockable rhythm is unlikely to be investigated in clinical trials and thus remains unknown. Objectives: To describe demographics, pre-hospital characteristics, interventions, and outcomes in OHCA patients with an initially shockable rhythm who did and did not get shocked in the field in DFW ROC site. Methods: We included all non-traumatic OHCA cases ≥18 years old with VF or VT as first known rhythms, who were treated and transported to a hospital within the DFW ROC site between 2006 - 2011. We report return of spontaneous circulation (ROSC) in the field and survival to hospital discharge for victims with and without shock delivered in the field. Multiple variable regression analysis assessed the association between shock delivery and ROSC in the field as well as survival. Results: Included were 882 adult non-traumatic OHCA cases with VF or VT as first known rhythms; mean (±SD) age was 60 ± 15 years, 71% male, bystander witnessed 56%, bystander resuscitation attempt 43%, public arrest location 26%, EMS response time 4.7 ± 2.3 min, 26.9% (237) had ROSC in the field, 14.9% (131) survived to hospital discharge; 93.4% (824) of all patients were shocked, while 6.6% (58) were not shocked. Of the 6.6% (58) who were not shocked, 12.1% (7) achieved ROSC in the field and 8.6% (5) survived to hospital discharge. For those not shocked in the field, the unadjusted and adjusted odds ratios for ROSC were 0.354 (95% CI 0.158-0.791, p=0.011) and 0.189 (95% CI 0.039-0.911, p=0.038), respectively; and for survival to hospital discharge they were 0.522 (95% CI 0.205-1.331, p=0.173) and 0.498 (95% CI 0.088-2.810, p=0.430), respectively. Conclusions: In the DFW ROC site, 6.6% of OHCA victims with an initially shockable rhythm did not receive a shock, which was significantly associated with decreased ROSC in the field. More patients survived who were shocked in the field, but this difference was not significant after adjustment for Utstein variables.

Abstract 98: The Association Between Manual Mode Defibrillation, Preshock Pause Duration and Appropriate Shock Delivery When Employed by Basic Life Support Paramedics During Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheldon Cheskes ◽  
Morgan Hillier ◽  
Cathy Zhan ◽  
Adam Byers ◽  
P R Verbeek ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Pause Duration ◽  
Absolute Difference ◽  
Secondary Outcome ◽  
Correct Identification ◽  
Shock Delivery ◽  
Inappropriate Shocks ◽  
Shockable Rhythm ◽  
Manual Mode

BACKGROUND: Pre-shock pause duration of < 20 seconds is associated with improved survival after cardiac arrest. Manual mode defibrillation has been associated with the shortest duration of pre-shock pause but is largely practiced by paramedics (EMT-P) whereas defibrillator only providers (EMT-D) routinely use the defibrillator in automatic mode. OBJECTIVE: We sought to explore the relationship between manual mode defibrillation, pre-shock pause duration and shock appropriateness when defibrillation is provided by EMT-P vs. EMT-D level of providers. METHODS: We performed a retrospective review of all treated non-traumatic adult OHCA presenting in a shockable rhythm over a one year period beginning January 1, 2012. Our primary outcome measure was the proportion of manual mode shocks delivered by EMT-D’s with pre- shock pause duration of < 20 secs when compared to EMT-P’s. Our secondary outcome measures were the duration of pre-, post- and peri-shock pause and the proportion of appropriate shocks (defined as correct identification and shock delivery to patients in a shockable rhythm) delivered by either level of provider. This study had a power of 90% to detect an absolute difference of 15% between provider levels in proportion of shocks delivered with pre-shock pause duration <20 secs. RESULTS: Among 2019 treated OHCA, 335(20%) presented in a shockable rhythm. Manual defibrillation was performed in 155 (46%) of these cases (196 shocks by EMT-P, 143 shocks by EMT-D). There were no differences in the proportion of shocks delivered with pre-shock pause duration <20 secs (EMT-P 82.8% vs EMT-D 84.8%, p =.65) nor pre-shock pause duration (sec) (median, Q1, Q3); EMT-P: 12.0 (7.0,17.0) vs. EMT-D: 11.0 (5.0,17.0), p= .13 while EMT-D had shorter peri- shock pause duration (sec) (median, Q1, Q3); EMT-P: 17.0 (12.0, 23.0) vs. EMT-D: 15.0 (9.0, 22.0), p =.03. There were no differences in the rate of inappropriate shocks (EMT-P 1.0% vs EMT-D 0.7%), p=1.0. CONCLUSIONS: Manual mode defibrillation by EMT-D’s produced similar measures of pre-shock pause when compared to EMT-P’s without increasing the rate of inappropriate shocks. More widespread use of EMT-D manual mode defibrillation may have the potential to decrease shock pause duration and improve survival.

Abstract 254: High Shock Efficacy and Algorithm Performance for a 150J Biphasic Waveform AED Used by Lay and BLS Responders During Out-of-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Stacy Gehman ◽  
Edward Kompare ◽  
Barbara Fink ◽  
Tim Johnson ◽  
Walter Hufford ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Normal Sinus Rhythm ◽  
Convenience Sample ◽  
Shock Delivery ◽  
Shockable Rhythm ◽  
Normal Sinus ◽  
High Shock ◽  
Biphasic Waveform ◽  
Post Shock ◽  
Hospital Cardiac Arrest

Introduction: Effective AED defibrillation of out of hospital cardiac arrest (OHCA) depends on the safe and effective identification of shockable rhythms, and on delivery of effective defibrillation energy. This report summarizes rhythm detection performance and shock efficacy during OHCA uses of Philips HeartStart Home and OnSite AEDs using non-escalating 150 J therapy. Methods: A convenience sample of 185 OHCA AED patient uses were reviewed by clinical experts. All analysis periods that resulted in AED rhythm advisories (Shock Advised or No Shock Advised) were annotated. Shockable rhythm categories include VF and polymorphic VT/flutter. Non-Shockable rhythm categories include normal sinus rhythm, other rhythms (e.g., atrial fibrillation/flutter, bradycardia, SVT, idioventricular, bundle branch block), and asystole. Intermediate rhythms (benefits of defibrillation are limited or uncertain) were not included. Post-shock rhythm was categorized as shockable, non-shockable, or undeterminable (rhythms corrupted by CPR artifact or pads removal within 5-s of shock delivery). Shock success was defined as conversion to a non-shockable rhythm within 5-s post-shock. Results: A total of 487 analysis periods resulted in AED rhythm advisories, with 175 annotated as Shockable and 312 Non-shockable. Sensitivity and specificity (n/N, Exact 95% CI) were 97.7% (171/175, 94.3%, 99.4%) and 100% (312/312, 98.8%, 100.0%) respectively. A total of 165 shocks were delivered to 100 patients with 5 undeterminable post-shock rhythms. The remaining 160 shocks were delivered to 156 Shockable rhythm episodes. All shock efficacy was 96.9% (155/160, 92.9%, 99.0%): 150 episodes converted to non-shockable rhythms after one shock (96.2% (150/156, 91.8%, 98.6%)); 154 after two shocks (98.7% (154/156, 95.4%, 99.8%)); and 155 after three shocks, the first two of which were undeterminable (99.4% (155/156, 96.5%, 100.0%)). The remaining episode had a failed first shock, followed by an undeterminable second shock, which was the last shock of the use. Conclusion: For these 150J fixed-energy AEDs, OHCA defibrillation is safe (100% specificity), and effective (97.7% sensitivity; 96.2% single shock effectiveness; 98.7% after two shocks; 99.4% after three shocks).

Abstract 123: Field Accuracy of Paramedic Shock Delivery Using a Filtered ECG Rhythm

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Hill Stoecklein ◽  
Andrew Pugh ◽  
Michael Stroud ◽  
Scott Youngquist
Keyword(s):  
Cardiac Arrest ◽  
Salt Lake ◽  
Survival Rates ◽  
Salt Lake City ◽  
Fire Department ◽  
Shock Delivery ◽  
Shockable Rhythm ◽  
Lake City ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Introduction: Recognition and rapid defibrillation of shockable rhythms is strongly associated with increased survival from out-of-hospital cardiac arrest (OHCA). The Salt Lake City Fire Department (SLCFD) adopted ECG rhythm filtering technology in 2011, along with a protocol to rapidly defibrillate shockable rhythms without awaiting the end of the 2-minute CPR epoch. Paramedics were also trained to empirically shock asystole, as studies have shown poor agreement in cases of fine and moderate amplitude Ventricular Fibrillation (VF). Hypothesis: We hypothesized that the mandate to shock perceived asystole plus the use of filtering technology would result in high case sensitivity for shockable rhythms at the expense of an unknown frequency of shock delivery to organized rhythms. Methods: Prospectively collected defibrillator data from cardiac arrest cases treated by SLCFD between Dec 2011 and June 2019 were analyzed. Timing of rhythm changes and defibrillation events was manually abstracted using the manufacturer’s review software. The gold standard for rhythm interpretation was post-incident physician interpretation. Results: Paramedics attempted resuscitation in 942 OHCAs. We excluded 41 pediatric cases, 140 cases of BLS or bystander-only AED resuscitation, and 65 cases in which the defibrillator file was unavailable. Overall, 696 adult cardiac arrests with 1,389 shocks delivered were available for analysis. Shocks were delivered to 958 (69%) shockable, 261 (19%) asystole, 158 (11%) PEA, 4 (0.3%) SVT, and 8 (0.6%) unknown underlying rhythms. In 280 cases no shock was delivered despite an initial shockable rhythm in 3 of these cases. Shock delivery case sensitivity was 180/183 (0.98, 95% confidence interval [CI]:0.97-1.0) with false positive proportion of delivered shocks of 158/1,389 (0.11, 95% CI:0.10-0.13) for PEA only and 419/1,389 (0.30, 95% CI:0.28-0.33) for combined PEA and asystole. Neurologically intact (CPC 1-2) overall and Utstein survival rates were 15% and 46% respectively. Conclusions: Using ECG rhythm-filtering technology and an aggressive protocol to defibrillate VF and empirically shock asystole, we demonstrated high case sensitivity for VF at the expense of an 11% rate of shock delivery to underlying PEA.

Outcomes after sudden cardiac arrest in sports centres with and without on-site external defibrillators

Heart ◽  
2018 ◽  
Vol 104 (16) ◽  
pp. 1344-1349 ◽  
Author(s):  
Daniela Aschieri ◽  
Diego Penela ◽  
Valentina Pelizzoni ◽  
Federico Guerra ◽  
Anna Chiara Vermi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Sudden Cardiac Arrest ◽  
Automated External Defibrillators ◽  
Shockable Rhythm ◽  
Tragic Event ◽  
Period Data ◽  
Neurologically Intact ◽  
Sports Activities

ObjectiveSudden cardiac arrest (SCA) is a rare but tragic event during amateur sports activities. Our aim is to analyse whether availability of automated external defibrillators (AEDs) in amateur sports centres could impact on SCA survival.MethodsThis is an observational study. During an 18-year period, data regarding exercise-related SCA in sports centres were prospectively collected. Survival rates and time to response were compared between centres with an AED already available and centres where an AED was not already present.ResultsOut of 252 sports facilities, 207 (82%) acquired an AED during follow-up while 45 (18%) did not. From 1999 to 2014, there were 26 SCAs (24 (92%) men, 54±17 years old) with 15 (58%) of them in centres with on-site AED. Neurologically intact survival rates were 93% in centres with on-site AED and 9% in centres without (P<0.001). Presence of on-site AED, presence of shockable rhythm, first assistance by a lay bystander and time to defibrillation were all related to neurological intact survival, but the presence of on-site AED was the only independent predictor in the multivariate analysis. The use of on-site AED resulted in a lower time to first shock when compared with emergency medical system-delivered AED (3.3±1.4min vs 7.3±3.2 min; P=0.001).ConclusionsThe presence of on-site AEDs is associated with neurologically intact survival after an exercise-related SCA. Continuous efforts are recommended in order to introduce AEDs in sports and fitness centres, implement educational programmes and increase common awareness about SCA.

Prescribing an automated external defibrillator for children at increased risk of sudden arrhythmic death

2017 ◽  
Vol 27 (7) ◽  
pp. 1271-1279
Author(s):  
Karen A. McLeod ◽  
Eileen Fern ◽  
Fiona Clements ◽  
Ruth McGowan
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Polymorphic Ventricular Tachycardia ◽  
Automated External Defibrillator ◽  
Automated External Defibrillators ◽  
Arrhythmic Death ◽  
Shockable Rhythm ◽  
Increased Risk ◽  
External Defibrillator

AbstractBackgroundAutomated external defibrillators can be life-saving in out-of-hospital cardiac arrest.ObjectiveOur aim was to review our experience of prescribing automated external defibrillators for children at increased risk of sudden arrhythmic death.MethodsWe reviewed all automated external defibrillators issued by the Scottish Paediatric Cardiac Electrophysiology Service from 2005 to 2015. All parents were given resuscitation training according to the Paediatric Resuscitation Guidelines, including the use of the automated external defibrillator.ResultsA total of 36 automated external defibrillators were issued to 36 families for 44 children (27 male). The mean age at issue was 8.8 years. Diagnoses at issue included long QT syndrome (50%), broad complex tachycardia (14%), hypertrophic cardiomyopathy (11%), and catecholaminergic polymorphic ventricular tachycardia (9%). During the study period, the automated external defibrillator was used in four (9%) children, and in all four the automated external defibrillator correctly discriminated between a shockable rhythm – polymorphic ventricular tachycardia/ventricular fibrillation in three patients with one or more shocks delivered – and non-shockable rhythm – sinus rhythm in one patient. Of the three children, two of them who received one or more shocks for ventricular fibrillation/polymorphic ventricular tachycardia survived, but one died as a result of recurrent torsades de pointes. There were no other deaths.ConclusionParents can be taught to recognise cardiac arrest, apply resuscitation skills, and use an automated external defibrillator. Prescribing an automated external defibrillator should be considered for children at increased risk of sudden arrhythmic death, especially where the risk/benefit ratio of an implantable defibrillator is unclear or delay to defibrillator implantation is deemed necessary.

Abstract 109: Automated External Defibrillators Are Rarely Used for In-Hospital Cardiac Arrest in Denmark

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mathilde Staerk ◽  
Kasper G Lauridsen ◽  
Kristian Krogh ◽  
Hans Kirkegaard ◽  
Bo Løfgren
Keyword(s):  
Cardiac Arrest ◽  
Hospital Setting ◽  
Spontaneous Circulation ◽  
Early Defibrillation ◽  
Automated External Defibrillators ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Rhythm Analysis ◽  
Hospital Cardiac Arrest ◽  
Cardiac Arrest Team

Introduction: Automated External Defibrillators (AEDs) are widely distributed in the pre-hospital setting and reported to reduce time to defibrillation and increase survival from out-of-hospital cardiac arrest. During in-hospital cardiac arrest (IHCA), AEDs may allow for early defibrillation before the cardiac arrest team arrives with a manual defibrillator. However, the effect of AEDs for IHCA remains unclear. This study aimed to investigate AED usage and contribution to defibrillation before cardiac arrest team arrival during IHCA. Methods: We obtained data on IHCAs in 2016 and 2017 from the Danish nationwide registry on IHCA (DANARREST). Data included information on initial rhythm, type of defibrillator, time to first rhythm analysis, time to arrival of the cardiac arrest team, time to first defibrillation, and return of spontaneous circulation (ROSC). Results: Of 4,496 IHCAs, AEDs were used in 421 resuscitation attempts (9%). Time registrations were excluded for 6 non-shockable IHCAs due to errors in registration. Of the 421 IHCAs, 82% (n=347) were non-shockable and 16% (n=68) were shockable (data missing for 6 IHCAs). ROSC was achieved in 46% (n=158) of patients with non-shockable rhythms and 59% (n=40) of patients with shockable rhythms. For IHCAs with a shockable rhythm and usage of an AED, rhythm analysis was performed before arrival of the cardiac arrest team in 50% (n=34) of cases and defibrillation with an AED were performed in 46% (n=27) of the cases. Patients with shockable rhythms defibrillated before arrival of the cardiac team, more often achieved ROSC compared to patients defibrillated after cardiac arrest team arrival (p=0.0024). Data regarding time registration are shown in the table. Conclusion: AEDs are used in approximately 1 of 10 resuscitation attempts in Danish hospitals and contribute to defibrillation before arrival of the cardiac arrest team in 1 of 14 cardiac arrest patients.

scholarly journals Association of subsequent shock after conversion to shockable rhythm with outcomes stratified by the type of initial non-shockable rhythm in children with out-of-hospital cardiac arrest

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
Y Goto ◽  
A Funada ◽  
T Maeda ◽  
Y Goto
Keyword(s):  
Cardiac Arrest ◽  
Prognostic Significance ◽  
Cerebral Performance Category ◽  
Pulseless Electrical Activity ◽  
Delivery Time ◽  
Shock Delivery ◽  
Shockable Rhythm ◽  
Significant Difference ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Japan Society for the Promotion of Science (Grant-in-Aid for Scientific Research) Background/Introduction: The rhythm conversion from initial non-shockable to shockable rhythm during cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) providers may be associated with neurologically intact survival after out-of-hospital cardiac arrest (OHCA) in children with an initial non-shockable rhythm. However, the prognostic significance of rhythm conversion stratified by the type of initial non-shockable rhythm is still unclear. Purpose We aimed to investigate the association of subsequent shock after rhythm conversion to shockable rhythm with neurologically intact survival and shock delivery time (time from EMS-initiated CPR to first shock delivery) by the type of initial non-shockable rhythm in children with OHCA. Methods We analysed the records of 19,095 children (age &lt;18 years) with OHCA treated by EMS providers. Data were obtained from a prospectively recorded Japanese nationwide Utstein-style database for a 13-year period (2005–2017). The primary outcome measure was 1-month neurologically intact survival, defined as cerebral performance category score of 1 to 2. Patients were divided into the initial pulseless electrical activity (PEA) (n = 3,326 [17.4%]) and initial asystole (n = 15,769 [82.6%]) groups. Results The proportion of patients who received subsequent shock after conversion to shockable rhythm was significantly higher in the initial PEA than in the initial asystole groups (3.3% [109/3,326] vs. 1.4% [227/15,769], p &lt; 0.0001). The shock delivery time was significantly shorter in the initial PEA than in the initial asystole groups (median [IQR], 8 min [5 min – 12 min] vs. 10 min [6 min – 16 min], p &lt; 0.01). Among the initial PEA patients, there was no significant difference between subsequently shocked (10.0% [11/109]) and subsequently non-shocked patients (6.0% [192/3,217], p = 0.10) regarding the rate of 1-month neurologically intact survival. However, after adjusting for 9 pre-hospital variables, subsequent shock with a delivery time of &lt;10 min was associated with increased odds of neurologically intact survival compared with no shock delivery (adjusted odds ratio [OR], 2.45; 95% confidence interval [CI], 1.16–5.16], p = 0.018). Among the initial asystole patients, the rate of 1-month neurologically intact survival was significantly higher in the subsequently shocked (4.4% [10/227]) than in the subsequently non-shocked (0.7% [106/15,542], p &lt; 0.0001). A multivariate logistic regression model showed that subsequent shock with a delivery time of &lt;10 min was associated with increased odds of neurologically intact survival compared with no shock delivery (adjusted OR, 9.77 [95% CI, 4.2–22.5], p &lt; 0.0001). Conclusions In children with OHCA with an initial non-shockable rhythm, subsequent shock after conversion to shockable rhythm during CPR was associated with increased odds of 1-month neurologically intact survival only when shock was delivered &lt;10 min from EMS-initiated CPR regardless of the type of initial rhythm.

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