• Alexis Cournoyer, Sylvie Cossette, Brian J Potter, Raoul Daoust, Luc de Montigny, Luc Londei-Leduc, Yoan Lamarche, Dave Ross, Judy Morris, Jean-Marc Chauny, Catalina Sokoloff, Jean Paquet, Martin Marquis, Martin Albert, Francis Bernard, Massimiliano Iseppon, Éric Notebaert, Yiorgos Alexandros Cavayas, and André Denault.
• Université de Montréal, Montréal, Québec, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada; Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada. Electronic address: alexis.cournoyer@umontreal.ca.
• Resuscitation. 2019 Jul 1; 140: 43-49.

ObjectiveFor patients suffering from an out-of-hospital cardiac arrest (OHCA), having an initial shockable rhythm is a marker of good prognosis. It has been suggested as one of the main prognosticating factors for the selection of patients for extracorporeal resuscitation (E-CPR). However, the prognostic implication of converting from a non-shockable to a shockable rhythm, as compared to having an initial shockable rhythm, remains uncertain, especially among patients that can otherwise be considered eligible for E-CPR. The objective of this study was to evaluate the association between the initial rhythm and its subsequent conversion and survival following an OHCA, for the general population and for E-CPR candidates.MethodsThis study used a registry of OHCA in Montreal, Canada. Adult patients suffering from a non-traumatic OHCA for whom the initial rhythm was known were included. The association between the initial rhythm and its subsequent conversion or not and survival to discharge was assessed using a multivariable logistic regression.ResultsOf 6681 included patients, 1788 (27%) had an initial shockable rhythm, 1749 (26%) had pulseless electrical activity (PEA) and no subsequent shockable rhythm, 295 (4%) had PEA and a subsequent shockable rhythm, 2694 (40%) had asystole and no subsequent shockable rhythm, and 155 (2%) asystole and a subsequent shockable rhythm. As compared to patients having an initial shockable rhythm, patients in all other groups had significantly lower odds of survival to hospital discharge (p < 0.001 for all comparisons). Univariate analyses were performed for E-CPR candidates. Among these 556 (8%) patients, more patients with an initial shockable rhythm survived than patients in all other groups (p < 0.001 for all comparisons).ConclusionsThe initial rhythm remains a much better prognostic marker than subsequent rhythms for all patients suffering from an OHCA, including in the subset of potential E-CPR candidates.Copyright © 2019 Elsevier B.V. All rights reserved.

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