Acute cardiac care & resuscitationCohort study
Defibrillation of persistent shockable rhythms and survival after in-hospital cardiac arrest
- national retrospective cohort study
- prospectively collected data from the Swedish Registry for Cardiopulmonary Resuscitation
- multivariable logistic regression
- missing data imputed
Authors' conclusion
A persistent shockable rhythm occurred in around one sixth of IHCAs with an initial shockable rhythm. Successive defibrillation attempts were associated with a rapid fall in survival followed by a plateau phase. These findings warrant further investigation, as patients with IHCA may also benefit from novel strategies to more rapidly terminate shockable rhythms.
Study context
- Population
- Adults with in-hospital cardiac arrest presenting with a shockable rhythm who received at least one defibrillation attempt, Sweden, 1 January 2010 to 31 December 2020In-hospital cardiac arrest (IHCA) cases included
- Participants
- 5,325 adults
- Exposure
- Number of defibrillation attempts and 30-day survival
- Outcome
- 30-day survival
- Follow-up
- 30 days
Main finding
As reported in the abstract
30-day survival with one defibrillation attempt
73%
30-day survival with four defibrillation attempts
41%
Minimum 30-day survival, at nine defibrillation attempts (plateau)
24%
Observational data: associations, not effects.
Further findings
Potentially modifiable in-hospital factors associated with decreased survival
| Comparison | aOR (95% CI) | |
|---|---|---|
| Unwitnessed arrest · associated with decreased survival · adjustment for patient and cardiac arrest factors | 0.50 (0.39–0.64) | |
| Absence of continuous cardiac monitoring · associated with decreased survival · adjustment for patient and cardiac arrest factors | 0.63 (0.54–0.74) | |
| 0.20.5125Adjusted odds ratio (log scale) |
| Outcome | aOR (per min) (95% CI) | |
|---|---|---|
| Potentially modifiable in-hospital factors associated with decreased survival — Longer time to the first defibrillation attempt · associated with decreased survival · adjustment for patient and cardiac arrest factors | 0.89 (0.86–0.91) | |
| 0.512Adjusted odds ratio (log scale) |
Persistent shockable rhythms
- Cases with persistent shockable rhythms
- 907 (17%)
Original publication
Summarised from the published abstract; every number is checked against it