Lupton et al reported clinical decisions rules to identify shock-refractory out-of-hospital cardiac arrest. One model is simple and the other is more complex. The authors are from Oregon Health & Science University in Portland.
Patient selection: out-of-hospital cardiac arrest
Criteria for shock-refractory cardiac arrest: >= 3 shocks required
Parameters:
(1) bystander AED shock
(2) first EMS rhythm (shockable or nonshockable)
(3) EMS-witnessed arrest
(4) sex
(5) time from first EMS dispatch in minutes
Bystander AED Shock
First EMS Rhythm
EMS Witnessed
Sex
Time to First EMS
Risk (Level)
no
nonshock
NA
NA
NA
lowest (0)
no
shockable
yes
NA
NA
low (1)
no
shockable
no
female
NA
low-mod-erate (2)
no
shockable
no
male
< 6 minutes
moderate (3)
no
shockable
no
male
>= 6 minutes
moderate-high (4)
yes
NA
NA
NA
NA
highest (5)
where:
• The item "non-shockable first EMS rhythm" as "yes" being low risk is inconsistent with data in Table 1.
Risk Level
Refractory VF/VT
lowest
30%
low
36%
low-moderate
49%
moderate
60%
moderate-high
64%
highest
85%
Simplified Risk Tree
Bystander AED Shock
First EMS Rhythm
EMS Witnessed Arrest
Risk
no
nonshockable
NA
low
no
NA
yes
low
no
shockable
no
moderate
yes
NA
NA
high risk
Risk Level
Refractory VF/VT
low
31%
moderate
58%
high
85%
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