Secondary shockable rhythms : prognosis in cardiac arrests with initial asystole or pulseless electrical activity and subsequent shockable rhythms
Bibliographic record
Abstract
Context There are numerous potential benefits to better understanding the prognosis of victims of initially non-shockable cardiac arrests including changes to future resuscitation care guidelines. Objective To evaluate whether out-of-hospital cardiac arrest outcomes for patients whose initial arrest rhythm is nonshockable improve or worsen with subsequent conversion to shockable rhythms. Design, Setting, and Patients This study is a cohort design secondary analysis of the prospectively-collected Cardiac Arrest Epidemiologic Registry (Epistry) organized by the Resuscitation Outcomes Consortium (ROC) of all out-of-hospital cardiac arrests at eight North American sites (6 US and 2 Canadian) between December 1, 2005, to May 31, 2007, followed through hospital discharge. The investigational cohort is identified as all EMS-treated adult (18 and older) cardiac arrest patients who presented in non-shockable rhythms (Pulseless Electrical Activity, Asystole, or Automated External Defibrillator non-shockable) and were treated by emergency medical services (EMS) personnel and had a non-traumatic cause of arrest. Main Outcome Measures Survival to hospital discharge. Methods Simultaneous analysis of multiply-imputed and complete-case datasets by logistic regression. Multiple imputation was used to permit analysis of all cases including cases with incomplete ascertainment of one or more covariates. Results A total of 6,662 adult atraumatic cardiac arrest cases found in non-shockable rhythmsmet our inclusion criteria and survival outcomes were known for 6,593 (98.96%) cases. Analysis of these data reveal survival to discharge in 2.69% of patients. In patients who later converted to shockable rhythms survival was 2.72% and in those who never converted to shockable rhythms survival was 2.68%, a statistically insignificant difference between these groups (two-tailed z-test, p = 0.9555). These results were similar after controlling for a set of potential confounders which were selected a priori to coincide with earlier research. Conclusion The results of this research do not agree with several previous studies which found that out-of-hospital cardiac arrest survival differs when non-shockable rhythms convert to shockable rhythms during the course of treatment nor do they agree with studies which found the opposite – that conversion to shockable rhythms was detrimental to patient survival. Our results suggest that cardiac arrest patients fare similarly in terms of survival to hospital discharge regardless of converting to shockable rhythms at subsequent rhythm assessment.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".