Association between conversion from an initial shockable rhythm to pulseless electrical activity before extracorporeal cardiopulmonary resuscitation and outcome: A secondary analysis of the SAVE-J II study - 07/10/25
, Akihiko Inoue, MD, PhD a, 1, Toru Hifumi, MD, PhD b, Takuya Taira, MD c, Taiki Moriyama, MD a, Masafumi Suga, MD a, Takeshi Nishimura, MD, PhD a, Tetsuya Sakamoto, MD, PhD d, Yasuhiro Kuroda, MD, PhD c, Satoshi Ishihara, MD, PhD aSAVE-J II Study Group
Highlights |
• | The rate of patients with favorable neurological outcomes was lower in patients who converted to PEA than in those with a sustained shockable rhythm (12.9 % vs 26.4 %, P < .01). |
• | By multivariable analysis, conversion to PEA was significantly associated with a lower rate of favorable neurological outcomes (odds ratio 0.42, 95% confidence interval 0.27-0.66; P < 0.01). |
• | The rate of favorable neurologic outcomes did not significantly differ between the patients who converted to PEA after hospital arrival and those with a sustainable shockable rhythm. |
• | Early conversion to PEA may be a factor for lower favorable neurological outcomes compared to those with sustained shockable rhythm. |
ABSTRACT |
Aim |
Shockable rhythm on initial electrocardiogram is a predictor of favorable neurological outcomes of out-of-hospital cardiac arrest in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). The present study evaluated the impact of conversion from shockable rhythm to pulseless electrical activity (PEA) before ECPR on patient outcomes.
Methods |
In this secondary analysis of the data from SAVE-J II, a retrospective multicenter registry including 36 participating institutions in Japan, patients with initial shockable rhythm were categorized into those with conversion to PEA and sustained shockable rhythm. The primary outcome was favorable neurological outcome, defined as a cerebral performance category of 1-2 at hospital discharge.
Results |
The final cohort included 718 patients. The rate of favorable neurological outcomes was lower in patients who were converted to PEA than in those with sustained shockable rhythm (12.9 % vs 26.4 %, P < .01). By multivariable analysis, conversion to PEA was significantly associated with a lower rate of favorable neurological outcomes (odds ratio 0.42, 95% confidence interval 0.27-0.66; P < .01). The rates of favorable neurologic outcomes were 9.8%, 18.0%, and 21.4% (P = .06) in patients who converted to PEA, during emergency medical services transport, at hospital arrival, and before ECMO initiation, respectively. However, outcomes did not significantly differ between the patients who converted to PEA after hospital arrival and those with sustained shockable rhythm (19.6% vs 26.4%, P = .19).
Conclusions |
Patients with conversion to PEA before ECPR were associated with a lower rate of favorable neurological outcomes in those with an initial shockable rhythm. Especially, early conversion to PEA, ie, during EMS transport, may be a factor for lower favorable neurological outcomes compared to those with sustained shockable rhythm.
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Vol 291
P. 144-152 - janvier 2026 Retour au numéro
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