title: The relationship between shocks and survival in out-of-hospital cardiac arrest patients initially found in PEA or asystole.
abstract: OBJECTIVE
  To describe survival rates from out-of-hospital cardiac arrest for patients who present with pulseless electrical activity or asystole according to whether they remained in a non-shockable rhythm or converted to ventricular fibrillation and were shocked appropriately.
  
  
  METHODS
  
  
  
  RESULTS
  Observational analysis of a cardiac arrest registry collected as part of a randomized trial.
  
  
  METHODS
  Five urban/suburban cities in the United States and Canada.
  
  
  METHODS
  Trial subjects (adult, treated, non-traumatic) whose first documented heart rhythm/state following cardiac arrest was asystole or pulseless electrical activity.
  
  
  METHODS
  Periodic pauses to assess for shockable rhythm.
  
  
  METHODS
  Survival to hospital discharge.
  
  
  RESULTS
  Of 1377 cardiac arrest patients, 738 presented with an initial arrest rhythm/state of either pulseless electrical activity or asystole. Of the 738, 78% (n=574) subsequently remained in a non-shockable rhythm/state at each evaluation throughout the resuscitation (No-Shock group) while 22% (n=164) converted to ventricular fibrillation and were shocked by emergency medical service (Shock group). Survival to hospital discharge was significantly greater in the No-Shock group (4.9% versus 0.6%, p=0.01). Shock group remained a predictor (odds ratios=0.18, p=0.036) of death after adjustment for potential confounders.
  
  
  CONCLUSIONS
  These results suggest that patients with cardiac arrest who develop VF during the course of treatment for initially observed pulseless electrical activity or asystole do not benefit from conventional approaches to treatment such as defibrillation. Further study is warranted to define the optimal treatment of this patient cohort.
authors: Department of Biostatistics, University of Washington, 1107 NE 45th St., Suite 505, Seattle, WA 98105-4689, USA. aph@u.washington.edu
authors: Al
authors: A
authors: Hallstrom
authors: Thomas D
authors: TD
authors: Rea
authors: Vince N
authors: VN
authors: Mosesso
authors: Leonard A
authors: LA
authors: Cobb
authors: Andy R
authors: AR
authors: Anton
authors: Lois
authors: L
authors: Van Ottingham
authors: Michael R
authors: MR
authors: Sayre
authors: James
authors: J
authors: Christenson
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology