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The prognostic significance of repeated prehospital shocks for out-of-hospital cardiac arrest survival

  • Alexis Cournoyer (a1) (a2) (a3), Éric Notebaert (a1) (a2), Sylvie Cossette (a3) (a4), Luc Londei-Leduc (a1) (a5) (a6), Luc de Montigny (a5), Dave Ross (a1) (a5), Yoan Lamarche (a1) (a7) (a8) (a9) (a10), Brian J. Potter (a1) (a11), Alain Vadeboncoeur (a1), Raoul Daoust (a1) (a2), Catalina Sokoloff (a1) (a6) (a12), Martin Albert (a1) (a7) (a9), Francis Bernard (a1) (a7) (a9), Judy Morris (a1) (a2), Jean Paquet (a13), Jean-Marc Chauny (a1) (a2), Massimiliano Iseppon (a1) (a2), Martin Marquis (a13), François de Champlain (a5) (a14) (a15), Yiorgos Alexandros Cavayas (a1) (a7) and André Denault (a1) (a9) (a12) (a16)...
Abstract

For a French translation of the original research, please see the Supplementary Material at DOI: 10.1017/cem.2018.437

CLINICIAN’S CAPSULE

What is known about the topic?

The prognostic implications of repeated shocks for out-of-hospital cardiac arrest are uncertain.

What did this study ask?

What is the association between the number of prehospital shocks and survival in patients suffering from an out-of-hospital cardiac arrest?

What did this study find?

Survival remains possible even after a high number of shocks for patients suffering from an OHCA.

Why does this study matter to clinicians?

The probabilities presented may prove useful in decision modelling to guide resuscitation efforts for these patients.

Objectifs

Les patients souffrant d’un arrêt cardiaque extrahospitalier (ACEH) dont le rythme initial est défibrillable sont à meilleur pronostic que si leur rythme initial ne l’est pas. Cependant, l’impact sur la survie de nécessiter de multiples défibrillations demeure incertain. L’objectif de cette étude est d’évaluer l’association entre le nombre de défibrillations préhospitalières et la survie au congé hospitalier chez les patients souffrant d’un ACEH.

Méthodes

Des patients adultes avec un rythme initial défibrillable tirés de cinq années d’un registre d’ACEH ont été inclus dans cette étude de cohorte. L’évolution de la survie au congé en fonction du nombre de défibrillations préhospitalières déjà administrées a été décrite à l’aide de probabilités dynamiques. L’association entre le nombre de défibrillations préhospitalières et la survie au congé a été évaluée à l’aide d’une régression logistique multivariée.

Résultats

Un total de 1,788 patients (Homme: 78%; âge moyen: 64 ans) ont été inclus dans l’analyse. Parmi ceux-ci, 536 (30%) ont été traités par des paramédics prodiguant des soins avancés en réanimation. Un tiers de la cohorte (583 patients, 33%) a survécu jusqu’à son congé hospitalier. La probabilité de survie était maximale à la première défibrillation (33% [intervalle de confiance à 95% 30%-35%]), puis diminuait jusqu’à 8% (intervalle de confiance à 95% 4%-13%) suite à neuf défibrillations. Une association entre la mortalité et un nombre plus élevé de défibrillations a été observée (rapport des cotes ajustés=0.88 [intervalle de confiance à 95% 0.85-0.92], p < 0.001).

Conclusions

Il demeure possible de survivre à un ACEH même après un grand nombre de défibrillations. Cependant, nécessiter plus de défibrillations est associé à une moins bonne survie pour ces patients.

Copyright
Corresponding author
Correspondence to: Dr. Alexis Cournoyer, Hôpital du Sacré-Cœur, 5400 Gouin Ouest, Montréal, QC H4J 1C5; Email: alexiscournoyermus@gmail.com
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