Acute cardiac care & resuscitation
Association between conversion from an initial shockable rhythm to pulseless electrical activity before extracorporeal cardiopulmonary resuscitation and outcome: A secondary analysis of the SAVE-J II study
Primary result · Favorable neurological outcome (cerebral performance category of 1-2)Result — go to the resultOdds ratio 0.42 95% CI 0.27–0.66Authors' conclusion
Patients with conversion to PEA before ECPR were associated with a lower rate of favorable neurological outcomes in those with an initial shockable rhythm. Especially, early conversion to PEA, ie, during EMS transport, may be a factor for lower favorable neurological outcomes compared to those with sustained shockable rhythm.
Study context
- Population
- Patients with out-of-hospital cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation (ECPR) with initial shockable rhythmfinal cohort
- Participants
- 718 patients
- Comparison
- Conversion to pulseless electrical activity (PEA) vs sustained shockable rhythm
- Primary endpoint
- Favorable neurological outcome (cerebral performance category of 1-2)
- Follow-up
- Hospital discharge
Methodological details36 participating institutions in Japan
- 36 participating institutions in Japan
Primary result
As reported in the abstract
Odds ratio
0.42
95% CI 0.27–0.66
P < 0.01
By group
Conversion to PEAvs sustained shockable rhythm
odds ratio 0.42 (95% CI 0.27–0.66); P < 0.01
Further findings
- Favorable neurological outcomes, conversion to PEA after hospital arrival vs sustained shockable rhythm — sustained shockable rhythm
- 26.4%
- Favorable neurological outcomes, conversion to PEA after hospital arrival vs sustained shockable rhythm — did not significantly differ
- P = .19
- Favorable neurologic outcomes by timing of conversion to PEA: during emergency medical services transport 9.8%
- Favorable neurologic outcomes by timing of conversion to PEA: at hospital arrival 18.0%
- Favorable neurologic outcomes by timing of conversion to PEA: before ECMO initiation 21.4%
- Favorable neurologic outcomes by timing of conversion to PEA: P = .06
- Favorable neurological outcomes, conversion to PEA after hospital arrival vs sustained shockable rhythm: converted to PEA after hospital arrival 19.6%
Original publication
Association between conversion from an initial shockable rhythm to pulseless electrical activity before extracorporeal cardiopulmonary resuscitation and outcome: A secondary analysis of the SAVE-J II study. Am Heart J. Published 22 August 2025. doi:10.
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