Acute cardiac care & resuscitation
Prediction of shock-refractory ventricular fibrillation in patients with out-of-hospital cardiac arrest: external validation of an electrocardiogram (ECG)-based approach
Authors' conclusion
A strategy using ECG features surrounding initial shock showed robust performance for predicting refractory VF in a distinct patient population.
Study context
- Population
- Patients with out-of-hospital cardiac arrest (OHCA) with an initial shockable rhythm and 3-s ECG segments before and after the initial shock, Seoul OHCA registry (2020–2023)included OHCA patients with initial shockable rhythm
- Participants
- 428 patients
- Exposure
- Logistic model of 25 ECG scalogram features predicting refractory ventricular fibrillation (VF), AUC compared against the original study's reported AUC
Methodological detailsexternal validation, leave-one-out cross-validation
- External validation
- Leave-one-out cross-validation
Further findings
Patients receiving ≥3 shocks during prehospital resuscitation
- Received ≥3 shocks
- 202 (47.2%)
Model performance (leave-one-out cross-validation (LOOCV) AUC) for refractory VF
- AUC for ≥3 total shocks (primary definition)
- 0.782 [95% CI 0.736-0.828]
- AUC for ≥3 consecutive shocks (alternative definition)
- 0.805 [95% CI 0.762-0.858]
- Leave-one-out cross-validation
AUC versus the original study's AUC of 0.846
- Not significantly different, ≥3 total shocks
- P = 0.060
- Not significantly different, ≥3 consecutive shocks
- P = 0.22
Original publication
Prediction of shock-refractory ventricular fibrillation in patients with out-of-hospital cardiac arrest: external validation of an ECG-based approach. Resuscitation. Published 30 April 2026. doi:10.
Summarised from the published abstract; every number is checked against it