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Clinical predictors of shockable versus non-shockable rhythms in patients with out-of-hospital cardiac arrest

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  • Asger Granfeldt
  • Mads Wissenberg, University of Copenhagen
  • ,
  • Steen Møller Hansen, Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aalborg, Denmark Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark Aalborg Atrial Fibrillation Study Group, Aalborg, Denmark., Aalborg University, Denmark
  • Freddy K Lippert, University of Copenhagen
  • ,
  • Torsten Lang-Jensen, Prehospital Emergency Medical Services, Southern Denmark Region, Denmark.
  • ,
  • Ole Mazur Hendriksen, Prehospital Emergency Medical Services, Zealand Denmark Region, Denmark.
  • ,
  • Christian Torp-Pedersen, Institute of Health, Science and Technology, Aalborg University, Denmark.
  • ,
  • Erika Frischknecht Christensen
  • Christian Fynbo Christiansen

AIM: To identify factors associated with a non-shockable rhythm as first recorded heart rhythm.

METHODS: Patients ≥18 years old suffering out-of-hospital cardiac arrest between 2001 and 2012 were identified in the population-based Danish Cardiac Arrest Registry. Danish administrative registries were used to identify chronic diseases (within 10 years) and drug prescriptions (within 180 days). A multivariable logistic regression model, including patient related and cardiac arrest related characteristics, was used to estimate odds ratios (OR) for factors associated with non-shockable rhythm.

RESULTS: A total of 29,863 patients were included: 6600 (22.1%) patients with a shockable rhythm and 23,263 (77.9%) patients with a non-shockable rhythm. A non-shockable rhythm was associated with female gender, arrest in private home, unwitnessed arrest, no bystander CPR, and longer time to first rhythm analysis compared to patients with shockable rhythm. In the adjusted multivariable regression model, pre-existing non-cardiovascular disease and drug prescription were associated with a non-shockable rhythm e.g. chronic obstructive lung disease (OR 1.44 [95% CI: 1.32-1.58]); and the prescription for antidepressants (OR 1.49 [95% CI: 1.35-1.65]), antipsychotics (OR 2.30 [95% CI: 1.96-2.69]) analgesics (OR 1.32 [95% CI: 1.23-1.41]), corticosteroids (OR 1.64 [95% CI: 1.44-1.85]), and antibiotics (OR 1.59 [95% CI: 1.40-1.81]). In contrast, the prescription of cardiovascular drugs and a history of cardiovascular disease e.g. ischemic heart disease was associated with a lower risk of non-shockable rhythm (OR 0.66 [95% CI: 0.60-0.71]).

CONCLUSION: This study demonstrate that non-cardiovascular disease and medication prescription are associated with a non-shockable rhythm while cardiovascular disease and medication prescription are associated with a shockable rhythm as first recorded rhythm in patients with OHCA.

Original languageEnglish
JournalResuscitation
Volume108
Pages (from-to)40-47
Number of pages8
ISSN0300-9572
DOIs
Publication statusPublished - Nov 2016

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