Factors associated with shock-refractory prehospital cardiac arrest

A significant number of out-of-hospital cardiac arrest (OHCA) patients experience refractory ventricular arrhythmias despite prompt defibrillation. These refractory arrhythmias are associated with poor clinical outcomes, underscoring the need to investigate improved management strategies. Therefore, this study aimed to identify factors associated with shock-refractory OHCA during the prehospital stages of resuscitation. This multicenter observational study included adult OHCA patients (age ≥ 18 years) from October 2015 to June 2022 who required at least one prehospital defibrillation. This study's primary endpoint was shock-refractory OHCA, defined as three defibrillation shocks during resuscitation. A logistic regression analysis was performed to identify factors associated with shock-refractory OHCA. Among the 4320 patients included, 1961 (45.4%) experienced shock-refractory OHCA. Male sex (adjusted odds ratio [aOR], 1.423; 95% confidence interval [CI], 1.209-1.676), bystander automated external defibrillator (AED) shock (OR 2.350; 95% CI 1.426-3.968), and initial shockable rhythm (OR 1.739; 95% CI 1.490-2.030) were associated with a high risk of shock-refractory, while old age (OR 0.993; 95% CI 0.989-0.998) and receive bystander cardiopulmonary resuscitation (CPR) (OR 0.829; 95% CI 0.718-0.958) were associated with a low risk of shock-refractory OHCA. This study showed that the prehospital factors of age, sex, initial rhythm, AED shock source, and absence of bystander CPR were associated with shock-refractory OHCA.

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Journal
Scientific Reports
Published
2025-08-18
DOI
https://doi.org/10.1038/s41598-025-11524-7
Primary Topic
Cardiac Arrest and Resuscitation
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article
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article

Factors associated with shock-refractory prehospital cardiac arrest

Sang Hoon Na, J. Lee, Se Jin Lee, Jae Chol Yoon et al.
Scientific Reports
Cardiac Arrest and Resuscitation
article

Factors associated with shock-refractory prehospital cardiac arrest

Sang Hoon Na, J. Lee, Se Jin Lee, Jae Chol Yoon, Ki Ok Ahn, Jai Woog Ko, Byuk Sung Ko, Seung-Sik Hwang, Jong Seok Lee, Seo Young Ko, Sang-Chan Jin, You Hwan Jo, Byoung Doo Rhee, Wonjoon Jeong, Min Seob Sim, Sung‐Hyuk Choi, Sung Hyun Yun, Jin-Sik Park, Kyung Hun Yoo, Jae-Hyug Woo, Gun Tak Lee, Jin Hee Jeong, Youngsuk Cho, Chul Min Ha, Ryeok Ahn, Young Taeck Oh, Sung Oh Hwang, Yun Jeong Hwang, Taeyoung Kong, Won Ho Kim, Sang Do Shin, Jin Woong Lee, Hyunggoo Kang, Tae-kwon Kim, Wook Tae Yang, Keun Hong Park, Jeong Ho Park, Hyung Joon Joo, Shin Young Ahn, Gu Hyun Kang, Young‐Hoon Yoon, Jong Whan Shin, Jinkun Bae, Yong Soo Jang, Sang O Park, Sung Phil Chung, Hui Jai Lee, Woo Jin Jung, Hyuk Jun Yang, Jin Hee Jung, Pyong-Wha Choi, Sang Ook Ha, Yong Oh Kim, In Byung Kim, Hang A Park, Hahn Bom Kim, Sung Wook Song, Jae Yun Ahn, Yoo Seok Park, Hyun Wook Ryu, Myoung Cheol Shin, Seulki Choi, Gyu Chong Cho, Wookjin Choi, Jong-Hak Park, Hyuna Hwang, Yuseok Moon, Gwan Jin Park, Changsun Kim, Dong Sun Choi, Ju Ok Park, Hyun Goo Shin, Eun Ha Kang, Kap Su Han, Arom Choi, Sung Min Park, Su Jin Kim, Sang Hun Lee, Ji Hoon Kim, Sung Hoon Kim, Sang Bong Lee, Youn‐Jung Kim, Won Seok Yang, Sung Wook Park, Sung‐Soo Park, Han Joo Choi, Young Hwan Lee, Sang Kuk Han, Jae Kwang Lee, Myung Hee Park, Tae Wan Jung, Joon-myoung Kwon, Juncheol Lee, Dain Wi, Tae Ho Lim, Young Ho Choi, Ki Young Jeong, Yong Hee Lee, Young Tae Park, Young Sik Kim, Sun Pyo Kim, Chong Sun Kim, Kyeong Min Lee, Kyung Sook Park, Won Young Kim, Seung Cheol Lee, Taek Geun Ohk, Kyung Jun Song, An Mu Eob
article en

Abstract

A significant number of out-of-hospital cardiac arrest (OHCA) patients experience refractory ventricular arrhythmias despite prompt defibrillation. These refractory arrhythmias are associated with poor clinical outcomes, underscoring the need to investigate improved management strategies. Therefore, this study aimed to identify factors associated with shock-refractory OHCA during the prehospital stages of resuscitation. This multicenter observational study included adult OHCA patients (age ≥ 18 years) from October 2015 to June 2022 who required at least one prehospital defibrillation. This study's primary endpoint was shock-refractory OHCA, defined as three defibrillation shocks during resuscitation. A logistic regression analysis was performed to identify factors associated with shock-refractory OHCA. Among the 4320 patients included, 1961 (45.4%) experienced shock-refractory OHCA. Male sex (adjusted odds ratio [aOR], 1.423; 95% confidence interval [CI], 1.209-1.676), bystander automated external defibrillator (AED) shock (OR 2.350; 95% CI 1.426-3.968), and initial shockable rhythm (OR 1.739; 95% CI 1.490-2.030) were associated with a high risk of shock-refractory, while old age (OR 0.993; 95% CI 0.989-0.998) and receive bystander cardiopulmonary resuscitation (CPR) (OR 0.829; 95% CI 0.718-0.958) were associated with a low risk of shock-refractory OHCA. This study showed that the prehospital factors of age, sex, initial rhythm, AED shock source, and absence of bystander CPR were associated with shock-refractory OHCA.

Scientific ReportsVol. 15(1)
Seoul National University (KR), Hallym University (KR), Gyeongju University (KR), Yonsei University (KR), Dongguk University (KR), Eulji University (KR), Severance Hospital (KR), Korea University Medical Center (KR), Bundang Jesaeng Hospital (KR), Kyungpook National University Hospital (KR), Asan Medical Center (KR), Samsung Medical Center (KR), Seoul National University Hospital (KR), Seoul National University Bundang Hospital (KR), Ansan University (KR), University of Ulsan (KR), Seoul Medical Center (KR), Gachon University Gil Medical Center (KR), Gyeongsang National University Hospital (KR), Konkuk University Medical Center (KR), Hallym University Kangnam Sacred Heart Hospital (KR), SNUH SMG-SNU Boramae Medical Center (KR), Chosun University Hospital (KR), Wonju Severance Christian Hospital (KR), Ajou University Hospital (KR), Konyang University Hospital (KR), Dongguk University Ilsan Hospital (KR), Kangwon National University Hospital (KR), Pusan National University Hospital (KR), Cheju Halla General Hospital (KR), Hanil General Hospital (KR), Hanyang University Guri Hospital (KR), Keimyung University Dongsan Medical Center (KR), Sejong General Hospital (KR), Jeonbuk National University Hospital (KR), CHA University Bundang Medical Center (KR), Kyung Hee University Dental Hospital (KR), Ulsan University Hospital (KR), Hanyang University Seoul Hospital (KR), Chungnam National University Hospital (KR), Myongji Hospital (KR), Gangnam Severance Hospital (KR), Kangdong Sacred Heart Hospital (KR), Catholic Kwandong University International St. Mary's Hospital (KR), Hallym University Dongtan Sacred Heart Hospital (KR), Hallym University Sacred Heart Hospital (KR), Chungbuk National University Hospital (KR), Hallym University Chuncheon Sacred Heart Hospital (KR), Jeju National University Hospital (KR), Dankook University Hospital (KR), Dongguk University WISE, Deleted Institution, Hanyang University (KR), Keimyung University (KR), Wonkwang University (KR), Jeonbuk National University (KR), Catholic Kwandong University (KR)
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