title: Prehospital Predictors of Initial Shockable Rhythm in Out-of-Hospital Cardiac Arrest: Findings From the Taichung Sudden Unexpected Death Registry (THUNDER).
abstract: To identify the incidence and prehospital predictors of ventricular tachycardia/ventricular fibrillation (VT/VF) as the initial arrhythmia in patients with out-of-hospital cardiac arrest (OHCA) in central Taiwan.
  
  
  
  The Taichung Sudden Unexpected Death Registry program encompasses the Taichung metropolitan area in central Taiwan, with a population of 2.7 million and 17 destination hospitals for patients with OHCA. We performed a detailed analysis of demographic characteristics, circumstances of cardiac arrest, and emergency medical service records using the Utstein Style.
  
  
  
  From May 1, 2013, through April 30, 2014, resuscitation was attempted in 2013 individuals with OHCA, of which 384 were excluded due to trauma and noncardiac etiologies. Of the 1629 patients with presumed cardiogenic OHCA, 7.9% (n=129) had initial shockable rhythm; this proportion increased to 18.8% (61 of 325) in the witnessed arrest subgroup. Male sex (odds ratio [OR], 2.45; 95% CI, 1.46-4.12; P<.001), age younger than 65 years (OR, 2.39, 95% CI, 1.58-3.62; P<.001), public location of arrest (OR, 4.61; 95% CI, 2.86-7.44; P<.001), and witnessed status (OR, 3.98; 95% CI, 2.62-6.05; P<.001) were independent predictors of VT/VF rhythm.
  
  
  
  The proportion of patients with OHCA presenting with VT/VF was generally low in this East Asian population. Of the prehospital factors associated with VT/VF, public location of OHCA was the strongest predictor of VT/VF in this population, which may affect planning and deployment of emergency medical services in central Taiwan.
authors.affiliation: Division of Cardiovascular Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Yen-Nien
authors.initials: YN
authors.lastname: Lin
authors.affiliation: Division of Cardiovascular Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Shih-Sheng
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Lee-Min
authors.initials: LM
authors.lastname: Wang
authors.affiliation: Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Hwan-Ting
authors.initials: HT
authors.lastname: Chi
authors.affiliation: School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Kwo-Chang
authors.initials: KC
authors.lastname: Ueng
authors.affiliation: School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Chin-Feng
authors.initials: CF
authors.lastname: Tsai
authors.affiliation: Department of Emergency, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Chee-Seong
authors.initials: CS
authors.lastname: Phan
authors.affiliation: Department of Emergency, Tung's Taichung MetroHabor Hospital, Taichung, Taiwan.
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Lu
authors.affiliation: Department of Emergency, Kuang Tien General Hospital, Taichung, Taiwan.
authors.forename: Choon-Hoon
authors.initials: CH
authors.lastname: Hii
authors.affiliation: Department of Emergency, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Chung
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
authors.affiliation: Division of Cardiovascular Medicine, China Medical University, Taichung, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ming-Fong
authors.initials: MF
authors.lastname: Chen
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan. Electronic address: tjwu@vghtc.gov.tw.
authors.forename: Tsu-Juey
authors.initials: TJ
authors.lastname: Wu
authors.affiliation: Division of Cardiovascular Medicine, China Medical University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital, Taichung, Taiwan. Electronic address: kuancheng.chang@gmail.com.
authors.forename: Kuan-Cheng
authors.initials: KC
authors.lastname: Chang
mesh_terms: D017677:Age Distribution; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004554:Electric Countershock; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D017678:Sex Distribution; D016019:Survival Analysis; D013610:Tachycardia / Q000453:epidemiology* / Q000209:etiology; D013624:Taiwan / Q000453:epidemiology; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014693:Ventricular Fibrillation / Q000453:epidemiology* / Q000209:etiology