Highlights
- •We compared PEA with Asystole in cases without bystander witness or bystander CPR.
- •Neurological outcome was more favorable in PEA than in Asystole.
- •Neurologically favorable survival rate was ≥1% in PEA even for patients aged ≥85 years.
- •Neurologically favorable survival rate was <1% in Asystole among all age groups.
- •PEA and Asystole should be distinguished from the perspective of medical futility.
Abstract
Background
Out-of-hospital cardiac arrest (OHCA) has a predominantly non-shockable rhythm. Non-shockable
rhythm, and the absence of a bystander witness or bystander cardiopulmonary resuscitation
(CPR) are associated with poor outcomes. However, the association between the type
of non-shockable rhythm and outcomes is not well known.
Objective
To examine the association between the initial rhythm and neurologically favorable
outcomes after non-shockable OHCA without a bystander witness or bystander CPR.
Methods
In a nationwide, population-based, cohort study, we analyzed 213,984 adult OHCA patients
with a non-shockable rhythm who had neither a bystander witness nor bystander CPR.
They were identified through the Japanese national OHCA registry data from January
1, 2005 to December 31, 2010. The primary outcome was neurologically favorable survival.
Results
Among 213,984 patients, the initial rhythm was Pulseless Electrical Activity (PEA)
in 31,179 patients (14.6%) and Asystole in 182,805 patients (85.4%). The neurological
outcome was more favorable in PEA than in Asystole (1.4% vs. 0.2%, p < 0.0001). After adjusting for age, sex, etiology of arrest, epinephrine administration,
advanced airway management, time from call to contact with patient, and calendar year,
PEA was associated with an increased neurologically favorable survival rate (odds
ratio 7.86; 95% confidence interval 6.81–9.07). In subgroup analysis stratified by
age group (18–64, 65–84, or ≥85 years), the neurologically favorable survival rate was ≥1% in PEA, even for patients aged ≥85 years, but <1% in Asystole among all age groups.
Conclusion
PEA and Asystole should not be considered to be identical to non-shockable rhythm,
but rather should be clearly distinguished from each other from the perspective of
quantitative medical futility.
Keywords
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Article Info
Publication History
Published online: March 01, 2016
Accepted:
January 25,
2016
Received in revised form:
January 7,
2016
Received:
October 10,
2015
Footnotes
☆Contributors: T. Fukuda, the principal investigator, participated in the study con- ception, design and completion, the data collection, management, and analysis, the interpretation of results and the revision of the manuscript and contributed to the final report. N. Ohashi-Fukuda, T. Matsubara, K. Doi, Y. Kitsuta, S. Nakajima, and N. Yahagi participated in the study con- ception, the data collection and management, and the interpretation of results. T. Fukuda performed the statistical analysis. All of the authors approved the final version. T. Fukuda takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
☆☆Role of the funding source: We received no funding for this study. There were no sponsors who played a role in the data analysis, the data interpretation, or the compo- sition of the report. The FDMA collected and managed the data, but played no role in the design or performance of the study. The corre- sponding author had full access to all of the data in the study and had final responsibility for the decision to submit the manuscript for publication.
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
