Factors for good neurological outcome in adult OHCA with initial shockable rhythm: a retrospective multicenter cohort study from the German Resuscitation Registry

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2025-07-05 DOI:10.1016/j.resplu.2025.101022

Stephan Katzenschlager , Nikolai Kaltschmidt , Simon Orlob , Frank Weilbacher , Matthias Huck , Stephan Seewald , Lisa Rück , Hanna Hoffmann , Erik Popp , Jan-Thorsten Gräsner , Jan Wnent

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Abstract

Study aim

This study examined defibrillation attempts during out-of-hospital cardiac arrest (OHCA) with shockable rhythm and survival outcomes, focusing on good neurological outcome at discharge. It aimed to identify predictors of favorable outcomes and guide future trials for alternative defibrillation strategies.

Methods

In this retrospective, multicenter cohort study, data were extracted from the German Resuscitation Registry for adult patients (≥18 years) who experienced OHCA with an initial shockable rhythm between January 2007 and December 2023. Only cases from good data quality centers were included. Patients were categorized according to the number of defibrillations received (1, 2–3, 4–6, and ≥7). Multivariable logistic regression was performed to identify independent predictors of favorable neurological outcomes.

Results

Out of 332,001 OHCA records, 15,284 met the inclusion criteria. Survival endpoints, including any return of spontaneous circulation, hospital admission with ROSC, 24-h survival, and survival to discharge, significantly declined with an increasing number of defibrillation attempts. In the regression analysis, EMS-witnessed arrests were strongly associated with favorable outcomes (OR 3.8; 95 % Confidence Interval 3.1–4.7). More defibrillations, prolonged ambulance response times, and older age were independently associated with lower odds of achieving a favorable neurological outcome.

Conclusion

An increasing number of defibrillations is independently linked to reduced survival and worse neurological outcomes in adults experiencing out-of-hospital cardiac arrest with an initial shockable rhythm. These results underscore the urgent need for alternative management strategies for multiple defibrillation attempts. These compelling observations warrant a reevaluation of defibrillation protocols to improve patient outcomes.

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具有初始震荡节律的成人OHCA患者良好神经预后的因素：来自德国复苏登记处的一项回顾性多中心队列研究

研究目的：本研究考察院外心脏骤停（OHCA）患者伴有震荡节律和生存结果时的除颤尝试，重点关注出院时良好的神经学预后。它旨在确定有利结果的预测因素，并指导未来替代除颤策略的试验。方法在这项回顾性、多中心队列研究中，从德国复苏登记中心提取了2007年1月至2023年12月期间出现初始震荡节律的OHCA成年患者（≥18岁）的数据。仅包括来自良好数据质量中心的案例。根据接受除颤术的次数（1、2-3、4-6和≥7次）对患者进行分类。采用多变量逻辑回归来确定有利神经预后的独立预测因子。结果332001份OHCA记录中，15284份符合纳入标准。生存终点，包括自发循环恢复、ROSC住院、24小时生存率和出院生存率，随着除颤次数的增加而显著下降。在回归分析中，ems目击的逮捕与有利的结果密切相关(OR 3.8；95%置信区间3.1-4.7)。更多的除颤器、延长的救护车反应时间和年龄的增长与较低的获得良好神经预后的几率独立相关。结论：在院外心脏骤停的成年人中，除颤器次数的增加与生存率降低和神经系统预后恶化独立相关。这些结果强调了对多次除颤尝试的替代管理策略的迫切需要。这些令人信服的观察结果为重新评估除颤方案以改善患者预后提供了依据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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