• Jie Li, Yongshu Zhang, Ming Long, Menghui Liu, Wanwan Zhang, Liwen Gu, Chen Su, Yan Xiong, Lichun Wang, and Ahamed Idris.
• Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China; Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, People's Republic of China; Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
• Resuscitation. 2020 Dec 1; 157: 141-148.

The Aim Of The StudyTo identify the prognostic factors and effects of implantable cardioverter-defibrillators (ICDs) in out-of-hospital cardiac arrest (OHCA) patients with ICDs because the clinical characteristics and outcomes of OHCA patients with ICDs are unknown.MethodsThe North American Resuscitation Outcomes Consortium (ROC) Cardiac Epistry Version 3 dataset was analyzed. Eligible patients were divided into OHCA patients with and without ICDs. Multivariable regressions were employed to analyze.ResultsOf 51,634 eligible OHCA patients, 581 (1.13%) had implanted ICDs. Among them, 53 (9.1%) patients survived to hospital discharge, and 40 (6.9%) patients had favorable neurological outcome at hospital discharge. Multivariable regression showed ICDs were not associated with OHCA outcomes in the total OHCA patients. In the OHCA patients with ICDs, shockable initial emergency medical services (EMS)-recorded rhythms and the ICD-shock-only defibrillation pattern were independent favorable factors for survival to hospital discharge(OR = 3.3, 95%CI 1.7-6.2, P < 0.001; OR = 2.4, 95%CI 1.1-5.5, P = 0.035, respectively) and neurological outcome at hospital discharge (OR = 6.5, 95%CI 2.9-14.4, P < 0.001; OR = 3.6, 95%CI 1.4-9.1, P = 0.006, respectively). During field resuscitation in OHCA patients with ICDs, at least 34.9% of total patients and 64.6% of patients with initial EMS-recorded VT/VF rhythms needed additional external shocks.ConclusionsShockable initial EMS-recorded rhythms and ICD-shock-only defibrillation pattern were independent factors for the favorable outcomes of OHCA patients with ICDs. ICDs were not associated with the outcomes of OHCA, and additional external shocks were needed in a substantial number of OHCA patients with ICDs during field resuscitation.Copyright © 2020 Elsevier B.V. All rights reserved.

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