• Kap Su Han, Sung Woo Lee, Eui Jung Lee, Moon Hwan Kwak, and Su Jin Kim.
• Department of Emergency Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-gu, Seoul, 02841, Republic of Korea.
• Resuscitation. 2019 Sep 1; 142: 144-152.

ObjectiveConversion to shockable rhythm from an initial non-shockable rhythm is associated with good neurologic prognoses in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether conversion to shockable rhythm has an association with good neurologic outcomes, according to the etiology of cardiac arrest.MethodsWe conducted a nationwide, population-based, cohort study using the OHCA data from the Korea Centers for Disease Control and Prevention database in 2012-2016. We included patients with OHCA and an initial non-shockable rhythm. The primary outcome was good neurologic outcome at discharge, etiologies of arrest were categorized to medical, non-medical cause. We analyzed the effect of conversion to a shockable rhythm on outcome according to causes of cardiac arrest using multiple regression analysis.ResultsOf 114,628 patients with an initial non-shockable rhythm, 25,042 (21.8%) experienced conversion to a shockable rhythm; 83,437 (72.8%) had medical causes and 31,191(27.2%) had non-medical causes. In all patients with OHCA and initial non-shockable rhythm, adjusted odds ratio (OR) of conversion for good neurologic outcome was 2.051 (95% confidence interval [CI] 1.181-2.297). The medical cause group showed an adjusted OR 1.789 (95% CI 1.586-2.019) of conversion for good neurologic outcome. In non-medical cause group, the adjusted OR of conversion was 0.644 (95% CI 0.372-1.114).ConclusionConversion to shockable rhythm had an association with good neurologic outcome in patients with OHCA with initial non-shockable rhythms, especially due to cardiac cause. However, rhythm conversion was not associated with better outcome in patients with non-medical causes.Copyright © 2019 Elsevier B.V. All rights reserved.

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