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Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients.
J Clin Med 2019; 8(9)JC

Abstract

Re-arrest during post-cardiac arrest care after the return of spontaneous circulation is not uncommon. However, little is known about the risk factors associated with re-arrest. A previous study failed to show a benefit of prophylactic antiarrhythmic drug infusion in all kinds of out-of-hospital cardiac arrest (OHCA) survivors. This study evaluated high-risk OHCA survivors who may have re-arrest with shockable rhythm during targeted temperature management (TTM). Medical records of consecutive OHCA survivors treated with TTM at four tertiary referral university hospitals in the Republic of Korea between January 2010 and December 2016 were retrospectively reviewed. Patients who did not have any shockable rhythm during cardiopulmonary resuscitation (CPR) or unknown initial rhythm were excluded. The primary outcome of interest was the recurrence of shockable cardiac arrest during TTM. There were 289 cases of initial shockable arrest rhythm and 132 cases of shockable rhythm during CPR. Of the 421 included patients, 11.4% of patients had a shockable re-arrest during TTM. Survival to discharge and good neurologic outcomes did not differ between non-shockable and shockable re-arrest patients (78.3% vs. 72.9%, p = 0.401; 53.1% vs. 54.2% p = 0.887). Initial serum magnesium level, ST segment depression or ventricular premature complex (VPC) in initial electrocardiography (ECG), prophylactic amiodarone infusion, and dopamine and norepinephrine infusion during TTM were significantly higher and more frequent in the shockable re-arrest group (all p values < 0.05). Normal ST and T wave in initial ECG was common in the non-shockable re-arrest group (p = 0.038). However, in multivariate logistic regression analysis, only VPC was an independent prognostic factor for shockable re-arrest (OR 2.806 (95% CI 1.276-6.171), p = 0.010). Initial VPC may be a prognostic risk factor for shockable re-arrest in OHCA survivors with shockable rhythm.

Authors+Show Affiliations

Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.Department of Emergency Medicine, Chonnam National University Medical School, Gwangju 61469, Korea.Department of Emergency Medicine, Chonnam National University Medical School, Gwangju 61469, Korea.Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.Department of Emergency Medicine, College of Medicine, Korea University, Seoul 02841, Korea.Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea.Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea. wonpia73@naver.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31480615

Citation

Ryoo, Seung Mok, et al. "Prognostic Factors for Re-Arrest With Shockable Rhythm During Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients." Journal of Clinical Medicine, vol. 8, no. 9, 2019.
Ryoo SM, Lee DH, Lee BK, et al. Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients. J Clin Med. 2019;8(9).
Ryoo, S. M., Lee, D. H., Lee, B. K., Youn, C. S., Kim, Y. J., Kim, S. J., ... Kim, W. Y. (2019). Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients. Journal of Clinical Medicine, 8(9), doi:10.3390/jcm8091360.
Ryoo SM, et al. Prognostic Factors for Re-Arrest With Shockable Rhythm During Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients. J Clin Med. 2019 Sep 1;8(9) PubMed PMID: 31480615.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic Factors for Re-Arrest with Shockable Rhythm during Target Temperature Management in Out-Of-Hospital Shockable Cardiac Arrest Patients. AU - Ryoo,Seung Mok, AU - Lee,Dong Hun, AU - Lee,Byung Kook, AU - Youn,Chun Song, AU - Kim,Youn-Jung, AU - Kim,Su Jin, AU - Kim,Yong Hwan, AU - Kim,Won Young, Y1 - 2019/09/01/ PY - 2019/07/08/received PY - 2019/08/09/revised PY - 2019/08/27/accepted PY - 2019/9/5/entrez PY - 2019/9/5/pubmed PY - 2019/9/5/medline KW - cardiac arrest KW - risk factors KW - ventricular fibrillation KW - ventricular premature complex KW - ventricular tachycardia JF - Journal of clinical medicine JO - J Clin Med VL - 8 IS - 9 N2 - Re-arrest during post-cardiac arrest care after the return of spontaneous circulation is not uncommon. However, little is known about the risk factors associated with re-arrest. A previous study failed to show a benefit of prophylactic antiarrhythmic drug infusion in all kinds of out-of-hospital cardiac arrest (OHCA) survivors. This study evaluated high-risk OHCA survivors who may have re-arrest with shockable rhythm during targeted temperature management (TTM). Medical records of consecutive OHCA survivors treated with TTM at four tertiary referral university hospitals in the Republic of Korea between January 2010 and December 2016 were retrospectively reviewed. Patients who did not have any shockable rhythm during cardiopulmonary resuscitation (CPR) or unknown initial rhythm were excluded. The primary outcome of interest was the recurrence of shockable cardiac arrest during TTM. There were 289 cases of initial shockable arrest rhythm and 132 cases of shockable rhythm during CPR. Of the 421 included patients, 11.4% of patients had a shockable re-arrest during TTM. Survival to discharge and good neurologic outcomes did not differ between non-shockable and shockable re-arrest patients (78.3% vs. 72.9%, p = 0.401; 53.1% vs. 54.2% p = 0.887). Initial serum magnesium level, ST segment depression or ventricular premature complex (VPC) in initial electrocardiography (ECG), prophylactic amiodarone infusion, and dopamine and norepinephrine infusion during TTM were significantly higher and more frequent in the shockable re-arrest group (all p values < 0.05). Normal ST and T wave in initial ECG was common in the non-shockable re-arrest group (p = 0.038). However, in multivariate logistic regression analysis, only VPC was an independent prognostic factor for shockable re-arrest (OR 2.806 (95% CI 1.276-6.171), p = 0.010). Initial VPC may be a prognostic risk factor for shockable re-arrest in OHCA survivors with shockable rhythm. SN - 2077-0383 UR - https://www.unboundmedicine.com/medline/citation/31480615/Prognostic_Factors_for_Re_Arrest_with_Shockable_Rhythm_during_Target_Temperature_Management_in_Out_Of_Hospital_Shockable_Cardiac_Arrest_Patients_ L2 - http://www.mdpi.com/resolver?pii=jcm8091360 DB - PRIME DP - Unbound Medicine ER -