Original articlePrehospital Predictors of Initial Shockable Rhythm in Out-of-Hospital Cardiac Arrest: Findings From the Taichung Sudden Unexpected Death Registry (THUNDER)
Section snippets
Study Design and Setting
The THUNDER program, which started May 1, 2013, encompasses Taichung and 17 destination hospitals for patients with OHCA. Taichung, located in central Taiwan, encompasses 2215 km2 of mixed urban, suburban, and rural areas. In 2014, the total population of Taichung was 2,711,252 residents, and the population density was 1605 persons per square kilometer.15 This registry, which includes demographic information, emergency medical service (EMS) records, and hospital data, was constructed using the
Patients With OHCA
A total of 2013 patients with OHCA were initially resuscitated by emergency medical technicians (EMTs) before being transferred to hospitals in Taichung from May 1, 2013, through April 30, 2014. After excluding 232 patients with major trauma, 93 with noncardiac OHCA adjudicated by the expert committee for a variety of reasons (52 with poisoning, severe airway diseases, or suicide and 41 not sent to the hospital owing to apparent irreversible death), and 59 with EMS-witnessed cardiac arrests,
Discussion
From this large-scale population-based OHCA registry in central Taiwan, we found that the incidence of presumed cardiogenic OHCA was 60.1 per 100,000 person-years, which was comparable with those reported worldwide.5 Notably, among all cardiac arrests, the incidence of AED-read shockable rhythm was 7.9% (n=129), which increased to 18.8% (61 of 325) in the witnessed OHCA subgroup. The low incidence of AED-read shockable rhythm was replicated in a random sample of patients with cardiac OHCA with
Conclusion
The incidence of initial VT/VF rhythm was relatively low in this East Asian population compared with that in Western patients with OHCA. Although the frequency of VT/VF in the present OHCA population was low, patients who presented with initial VT/VF rhythm had favorable survival outcomes similar to the observations worldwide. Of the prehospital factors associated with VT/VF, public location of cardiac arrest was the strongest predictor of this rhythm. Further nationwide studies are necessary
Acknowledgments
We thank the THUNDER collaborators, including Health Bureau of Taichung City Government, Fire Bureau of Taichung City Government, Taiwan Heart Rhythm Society, China Medical University Hospital, Taichung Veterans General Hospital, Chung Shan Medical University Hospital, Tung’s Taichung MetroHabor Hospital, Cheng Ching Hospital, Taichung Hospital Ministry of Health and Welfare, Lin Shin Hospital, Feng Yuan Hospital Ministry of Health and Welfare, Taichung Armed Forces General Hospital, Jen-Ai
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2023, Heart Rhythm O2Comparison of outcomes between cardiogenic and non-cardiogenic cardiac arrest patients receiving targeted temperature management: The nationwide TIMECARD multicenter registry
2023, Journal of the Formosan Medical AssociationCitation Excerpt :Cardiogenic etiology was a potential predictor of better cardiac arrest survival, but it was not an independent risk factor for overall outcome after adjusting for potential covariates. Two-thirds of OHCA patients have a primary cardiac cause,25 and a higher incidence of shockable rhythm occurs among all cardiogenic CAs.28 Thus, immediate bystander CPR and the availability of AED are essential to increase survival and neurologic prognosis.29
Global disparities in arrhythmia care: Mind the gap
2022, Heart Rhythm O2Citation Excerpt :The main transport to a hospital for patients with witnessed OHCA was a taxi, with the remainder of patients brought directly to a mortuary after being presumed dead without attempted resuscitation.38 Several Asian registries have been established to measure the rate of survival after OHCA.39–41 Available data from the Taichung Sudden Unexpected Death Registry (THUNDER) in Taiwan reveal lower rates of a shockable rhythm (ventricular tachycardia or ventricular fibrillation) as a presenting rhythm in OHCA (19%) than in studies of Western populations.40
Prognostic value of early and late spontaneous conversion into a shockable rhythm for patients with out-of-hospital cardiac arrest
2022, American Journal of Emergency MedicineCitation Excerpt :Third, information bias cannot be excluded from a retrospective study design, although the dataset used in this study was prospectively collected from the Taichung Sudden Cardiac Arrest Registry. The reliability of this registry has been reported previously [11,29]. Fourth, rates of post-resuscitation care were significantly higher in the initial shockable and early conversion groups than in the non-conversion group, which may have affected outcomes after cardiac arrest.
Derivation and Validation of the SWAP Score for Very Early Prediction of Neurologic Outcome in Patients With Out-of-Hospital Cardiac Arrest
2019, Annals of Emergency MedicineCitation Excerpt :Thus, the application of SWAP score should be limited to patients with a similar clinical context. Furthermore, the incidence of shockable rhythm in this study was relatively low, possibly because we excluded patients with out-of-hospital return of spontaneous circulation, although relevant observational studies conducted in Asia have also shown a low incidence of shockable rhythm.17,24 The reason for the relatively low incidence of shockable rhythm in the Asian population remains unclear, which might affect the application of SWAP in non-Asian populations.
Grant Support: This study was supported in part by grant MOHW105-TDU-B-212-133019 from the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence; grants MOST 103-2314-B-039-029 and MOST 104-2314-B-039-048 from the Ministry of Science and Technology; and grants DMR-100-005, DMR-103-003, DMR-104-006, DMR-105-013, DMR-105-129, DMR-105-130, and DMR-105-139 from China Medical University Hospital. None of these funding sources had a further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.