Key result
Initial VPC on ECG linked to ~181% greater risk of shockable re-arrest during TTM.
Why the study?
Re-arrest during post-cardiac arrest care after ROSC is not uncommon, but risk factors associated with re-arrest remain poorly understood.
Cohort (n=421)
Yes
Odds Ratio: 2.806 (95% CI 1.276–6.171)
p-value: p=0.010
Ventricular premature complexes on initial ECG serve as an independent prognostic factor for shockable re-arrest in out-of-hospital cardiac arrest survivors undergoing targeted temperature management.
May flag higher re-arrest risk during TTM; hypothesis-generating and should not yet change practice.
Re-arrest during post-cardiac arrest care after the return of spontaneous circulation is not uncommon. However, little is known about the risk factors associated with re-arrest. A previous study failed to show a benefit of prophylactic antiarrhythmic drug infusion in all kinds of out-of-hospital cardiac arrest (OHCA) survivors. This study evaluated high-risk OHCA survivors who may have re-arrest with shockable rhythm during targeted temperature management (TTM). Medical records of consecutive OHCA survivors treated with TTM at four tertiary referral university hospitals in the Republic of Korea between January 2010 and December 2016 were retrospectively reviewed. Patients who did not have any shockable rhythm during cardiopulmonary resuscitation (CPR) or unknown initial rhythm were excluded. The primary outcome of interest was the recurrence of shockable cardiac arrest during TTM. There were 289 cases of initial shockable arrest rhythm and 132 cases of shockable rhythm during CPR. Of the 421 included patients, 11.4% of patients had a shockable re-arrest during TTM. Survival to discharge and good neurologic outcomes did not differ between non-shockable and shockable re-arrest patients (78.3% vs. 72.9%, p = 0.401; 53.1% vs. 54.2% p = 0.887). Initial serum magnesium level, ST segment depression or ventricular premature complex (VPC) in initial electrocardiography (ECG), prophylactic amiodarone infusion, and dopamine and norepinephrine infusion during TTM were significantly higher and more frequent in the shockable re-arrest group (all p values < 0.05). Normal ST and T wave in initial ECG was common in the non-shockable re-arrest group (p = 0.038). However, in multivariate logistic regression analysis, only VPC was an independent prognostic factor for shockable re-arrest (OR 2.806 (95% CI 1.276–6.171), p = 0.010). Initial VPC may be a prognostic risk factor for shockable re-arrest in OHCA survivors with shockable rhythm.
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Ryoo et al. (2019) conducted a cohort in Out-of-hospital cardiac arrest (OHCA) (n=421). Ventricular premature complex (VPC) on initial ECG vs. No VPC on initial ECG was evaluated on Recurrence of shockable cardiac arrest during TTM (OR 2.806, 95% CI 1.276-6.171, p=0.010). Initial ventricular premature complex on ECG was an independent prognostic factor for shockable re-arrest during targeted temperature management in OHCA survivors (OR 2.806; 95% CI 1.276-6.171; P=0.010).
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