Yu-An Chen, Yen-Nien Lin, Shih-Sheng Chang, Ming-Fong Chen, Kuan-Cheng Chang
Background
Presentation with a shockable rhythm (ventricular tachycardia / fibrillation, VT/VF) is associated with the best survival in out-of-hospital cardiac arrest (OHCA), but there is significant regional variation in presentation and outcomes. We sought to identify the incidence and pre-hospital predictors of VT/VF as the initial arrhythmia in OHCA patients in central Taiwan.
Presentation with a shockable rhythm (ventricular tachycardia / fibrillation, VT/VF) is associated with the best survival in out-of-hospital cardiac arrest (OHCA), but there is significant regional variation in presentation and outcomes. We sought to identify the incidence and pre-hospital predictors of VT/VF as the initial arrhythmia in OHCA patients in central Taiwan.
Methods
The THUNDER program encompasses the Taichung metropolitan area in central Taiwan with a population size of 2.7 million and 17 destination hospitals for OHCA patients. We performed a detailed analysis of demographics, circumstances of cardiac arrest and emergency medical service records using the Utstein style.
The THUNDER program encompasses the Taichung metropolitan area in central Taiwan with a population size of 2.7 million and 17 destination hospitals for OHCA patients. We performed a detailed analysis of demographics, circumstances of cardiac arrest and emergency medical service records using the Utstein style.
Results
From May 1, 2013 to April 30, 2014, resuscitation was attempted in 2013 OHCA cases of which 384 cases were excluded due to trauma and non-cardiac etiologies. Of the 1629 patients with presumed cardiogenic OHCA, 7.9% had initial shockable rhythm. The proportion of shockable rhythm increased to 18.8% in witnessed arrest subgroup. Male gender (OR 2.45, 95% [CI] 1.46-4.12, P = 0.0007), age < 65 years (OR 2.39, 95% [CI] 1.58-3.62, P < 0.0001), public location of arrests (OR 4.61, 95% [CI] 2.86-7.44, P < 0.0001), and witnessed status (OR 3.98, 95% [CI] 2.62-6.05, P < 0.0001) were independent predictors of VT/VF rhythm.
From May 1, 2013 to April 30, 2014, resuscitation was attempted in 2013 OHCA cases of which 384 cases were excluded due to trauma and non-cardiac etiologies. Of the 1629 patients with presumed cardiogenic OHCA, 7.9% had initial shockable rhythm. The proportion of shockable rhythm increased to 18.8% in witnessed arrest subgroup. Male gender (OR 2.45, 95% [CI] 1.46-4.12, P = 0.0007), age < 65 years (OR 2.39, 95% [CI] 1.58-3.62, P < 0.0001), public location of arrests (OR 4.61, 95% [CI] 2.86-7.44, P < 0.0001), and witnessed status (OR 3.98, 95% [CI] 2.62-6.05, P < 0.0001) were independent predictors of VT/VF rhythm.
Conclusions
Compared to the US and Western Europe, the proportion of OHCA patients presenting with VT/VF was lower in this East Asian population. Among the pre-hospital factors associated with VT/VF, public location of OHCA was the strongest predictor of VT/VF in this population, which may impact planning and deployment of emergency medical services in central Taiwan.
Compared to the US and Western Europe, the proportion of OHCA patients presenting with VT/VF was lower in this East Asian population. Among the pre-hospital factors associated with VT/VF, public location of OHCA was the strongest predictor of VT/VF in this population, which may impact planning and deployment of emergency medical services in central Taiwan.
