Association Between No‐Flow Time, Prehospital Low‐Flow Time, and Conversion to Nonshockable Rhythm in Patients With Out‐of‐Hospital Cardiac Arrest Presenting With Initial Shockable Rhythm: A Nationwide Prospective Study in Japan
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Out-of-hospital cardiac arrest (OHCA) with initial shockable rhythm generally has a favorable prognosis. However, the prognosis worsens when this rhythm transitions to nonshockable rhythm on hospital arrival. This study aimed to investigate the association between no-flow time (NFT), prehospital low-flow time (LFT), and the conversion to nonshockable rhythm on hospital arrival in patients with OHCA initially exhibiting shockable rhythm. METHODS: We analyzed adult patients with OHCA from the JAAM-OHCA (Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest) registry (June 2014-December 2020) with initial shockable rhythm. The primary outcome was rhythm conversion to nonshockable on hospital arrival. Adjusted odds ratios (aORs) with 95% CIs were calculated using a logistic model to examine the associations between NFT, prehospital LFT, and rhythm conversion. RESULTS: Of 68 110 patients, 3720 patients were included in our analysis. On hospital arrival, 27.9% patients achieved return of spontaneous circulation, 32.8% maintained shockable rhythm, and 39.3% transitioned to nonshockable rhythm (718 to pulseless electrical activity, 744 to asystole). Median NFT was 4 minutes (interquartile range [IQR], 1-9 minutes), and median prehospital LFT was 22 minutes (IQR, 14-31 minutes). Longer NFT and prehospital LFT were associated with higher aORs of rhythm conversion: NFT (5-9 minutes: aOR, 1.38 [95% CI, 1.14-1.67]; ≥10 minutes: aOR, 1.75 [95% CI, 1.44-2.14]); and prehospital LFT (15-19 minutes: aOR, 2.56 [95% CI, 2.00-3.27]; 20-29 minutes, aOR, 4.73 [95% CI, 3.83-5.85]; ≥30 minutes, aOR, 6.85 [95% CI, 5.49-8.56]). CONCLUSIONS: Prolonged NFT and prehospital LFT were significantly associated with rhythm conversion to nonshockable on hospital arrival in patients with OHCA with initial shockable rhythm at the scene.
Institutions: Shiga University of Medical Science, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto Prefectural University of Medicine, University Hospital Kyoto Prefectural University of Medicine, The University of Osaka, National University of Singapore, Kyoto University, Duke-NUS Medical School
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
Awards: Evidences for Improving Out-of-Hospital Cardiac Arrest Patient Outcomes for Personalized Medicine: A Registry Study, Innovation in cardiopulmonary resuscitation techniques using non-invasive carotid and venous blood flow monitoring, Resuscitation Circulatory Mechanisms and Effective Indicators in Cardiac Arrest Patients Using Physiological Indices
OpenAlex ID: W4407974541