{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T02:11:24Z","timestamp":1783822284132,"version":"3.55.0"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Clinical features among patients with refractory out-of-hospital cardiac arrest (OHCA) and initial shockable rhythms of ventricular fibrillation\/pulseless ventricular tachycardia are not well-characterized.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We compared clinical characteristics and coronary angiographic findings between patients with refractory OHCA (incessant ventricular fibrillation\/pulseless ventricular tachycardia after \u22653 direct-current shocks) and those without refractory OHCA.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Between 2014 and 2018, a total of 204 patients with ventricular fibrillation\/pulseless ventricular tachycardia OHCA (median age 62; males 78%) were divided into groups with (36%, 74\/204) and without refractory arrest (64%, 130\/204). Refractory OHCA patients had longer cardiopulmonary resuscitation (23 versus 15 minutes), more frequently required \u2265450 mg amiodarone (34% versus 3.8%), and had cardiogenic shock (80% versus 55%) necessitating higher adrenaline dose (4.0 versus 1.0 mg) and higher rates of mechanical ventilation (92% versus 74%; all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01). Of 167 patients (82%) selected for coronary angiography, 33% (n=55) had refractory OHCA (\n              <jats:italic>P<\/jats:italic>\n              =0.035). Significant coronary artery disease (\u22651 major vessel with &gt;70% stenosis) was present in &gt;70% of patients. Refractory OHCA patients frequently had acute coronary occlusion (64% versus 47%), especially left circumflex (20% versus 6.4%) and graft vessel (7.3% versus 0.9%; all\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05) compared with those without refractory OHCA. Refractory OHCA group had higher in-hospital mortality (45% versus 30%,\n              <jats:italic>P<\/jats:italic>\n              =0.036) and greater new requirement for dialysis (18% versus 6.3%,\n              <jats:italic>P<\/jats:italic>\n              =0.011). After adjustment, refractory OHCA was associated with over 2-fold higher odds of in-hospital mortality (odds ratio, 2.28 [95% CI, 1.06\u20134.89];\n              <jats:italic>P<\/jats:italic>\n              =0.034).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Refractory ventricular fibrillation\/pulseless ventricular tachycardia OHCA was associated with more intensive resuscitation, higher rates of acute coronary occlusion, and poorer in-hospital outcomes, underscoring the need for future studies in this extreme-risk subgroup.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.123.013007","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T09:00:17Z","timestamp":1695718817000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Clinical Features and Outcomes Among Patients With Refractory Out-of-Hospital Cardiac Arrest and an Initial Shockable Rhythm"],"prefix":"10.1161","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9071-6296","authenticated-orcid":true,"given":"Wayne C.","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maye C.","family":"Zheng","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, University of New South Wales, Sydney, Australia (M.C.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6831-6939","authenticated-orcid":true,"given":"Felicia C.S.","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer","family":"Noaman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)."},{"name":"Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kawa","family":"Haji","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riley J.","family":"Batchelor","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Royal Melbourne Hospital, Australia (R.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura B.","family":"Hanson","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)."},{"name":"Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8838-0332","authenticated-orcid":true,"given":"Jason E.","family":"Bloom","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)."},{"name":"Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia (J.E.B., J.A.S., D.S., D.M.K., W.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)."},{"name":"Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia (J.E.B., J.A.S., D.S., D.M.K., W.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8787-1217","authenticated-orcid":true,"given":"Yang","family":"Yang","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Western Health, Melbourne, Australia (Y.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8686-2709","authenticated-orcid":true,"given":"Dion","family":"Stub","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)."},{"name":"Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia (J.E.B., J.A.S., D.S., D.M.K., W.C.)."},{"name":"School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia (D.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7442-2829","authenticated-orcid":true,"given":"Nicholas","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Western Health, Melbourne, Australia (F.C.S.H., S.N., K.H., L.B.H., N.C., W.C.)."},{"name":"Department of Medicine, The University of Melbourne, Australia (N.C., W.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4058-0372","authenticated-orcid":true,"given":"David M.","family":"Kaye","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Alfred Health, Melbourne, Australia (W.C.Z., S.N., L.B.H., J.E.B., J.A.S., D.S., D.M.K., W.C.)."},{"name":"Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia (J.E.B., J.A.S., D.S., D.M.K., 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