Rhythm conversion in out-of-hospital cardiac arrest and influence on the return of spontaneous circulation at the hospital arrival: a 10-year retrospective study in Croatia

Rhythm conversion in out-of-hospital cardiac arrest and influence on the return of spontaneous circulation at the hospital arrival: a 10-year retrospective study in Croatia

Out-of-hospital cardiac arrest, Return of spontaneous circulation, Rhythm conversion

Abstract
Background While initial non-shockable (NS) rhythms are often associated with poor prognosis, the conversion
to shockable rhythms during cardiopulmonary resuscitation (CPR) can significantly influence survival rates. This
retrospective cohort study investigated the impact of rhythm conversion on the return of spontaneous circulation
(ROSC) in out-of-hospital cardiac arrest (OHCA) patients.
Methods The study analyzed data recorded from January 2012 to August 2022 obtained from the Utstein Templates
from The Institute of Emergency Medicine of the City of Zagreb. Statistical analysis, including logistic regression, was
performed to assess the likelihood of achieving maintained ROSC.
Results Study included 2791 cases of OHCA with emergency medical service attempts at resuscitation. A total of
74.92% of patients had an initial NS rhythm with a total conversion rate of 18.27%. Factors significantly associated with
rhythm conversion were younger age, male sex (74.13%), public place (32.35%) of and witnessed collapse (75.98%),
higher adrenaline dose, use of a mechanical compression machine (41.68%), and shorter response interval. There
was no significant difference in the occurrence of conversion between the cases with initial asystole and pulseless
electrical activity (PEA). However, cases with converted asystole (33.48%) compared to the ones with converted PEA
(20.65%) had significantly greater ROSC maintenance (p=0.006), as well as when compared to cases with sustained
PEA (20.93%, p<0.001). Logistic regression revealed that women with rhythm conversion, lower adrenaline doses, and
provided bystander CPR were significantly more likely to achieve ROSC at hospital admission (P<0.001).
Conclusions This comprehensive study sheds light on the importance of rhythm conversion in patients with OHCA,
with greater ROSC achievement, especially in patients with initial asystole, than in patients with initial PEA.
Keywords Out-of-hospital cardiac arrest, Return of spontaneous circulation, Rhythm conversion

Josip Lovaković1

, Porin Šantek2

, Luka Matej Mahečić3

, Ivana Rožić2

, Jana Marić4

, Đivo Čučević5

, Lorka Tarnovski6*,

Dejana Martinić2
, Fran Rašić7
and Žarko Rašić8

https://doi.org/10.1186/s12245-024-00746-7

2024

Peri Irawan

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