{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:09:55Z","timestamp":1788876595342,"version":"build-2803163510"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Out\u2010of\u2010hospital cardiac arrest (OHCA) with initial shockable rhythm generally has a favorable prognosis. However, the prognosis worsens when this rhythm transitions to nonshockable rhythm on hospital arrival. This study aimed to investigate the association between no\u2010flow time (NFT), prehospital low\u2010flow time (LFT), and the conversion to nonshockable rhythm on hospital arrival in patients with OHCA initially exhibiting shockable rhythm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We analyzed adult patients with OHCA from the JAAM\u2010OHCA (Japanese Association for Acute Medicine Out\u2010of\u2010Hospital Cardiac Arrest) registry (June 2014\u2013December 2020) with initial shockable rhythm. The primary outcome was rhythm conversion to nonshockable on hospital arrival. Adjusted odds ratios (aORs) with 95% CIs were calculated using a logistic model to examine the associations between NFT, prehospital LFT, and rhythm conversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Of 68\u2009110 patients, 3720 patients were included in our analysis. On hospital arrival, 27.9% patients achieved return of spontaneous circulation, 32.8% maintained shockable rhythm, and 39.3% transitioned to nonshockable rhythm (718 to pulseless electrical activity, 744 to asystole). Median NFT was 4\u2009minutes (interquartile range [IQR], 1\u20139 minutes), and median prehospital LFT was 22\u2009minutes (IQR, 14\u201331 minutes). Longer NFT and prehospital LFT were associated with higher aORs of rhythm conversion: NFT (5\u20139\u2009minutes: aOR, 1.38 [95% CI, 1.14\u20131.67]; \u226510\u2009minutes: aOR, 1.75 [95% CI, 1.44\u20132.14]); and prehospital LFT (15\u201319\u2009minutes: aOR, 2.56 [95% CI, 2.00\u20133.27]; 20\u201329\u2009minutes, aOR, 4.73 [95% CI, 3.83\u20135.85]; \u226530\u2009minutes, aOR, 6.85 [95% CI, 5.49\u20138.56]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Prolonged NFT and prehospital LFT were significantly associated with rhythm conversion to nonshockable on hospital arrival in patients with OHCA with initial shockable rhythm at the scene.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.038725","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T06:10:51Z","timestamp":1740550251000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Association Between No\u2010Flow Time, Prehospital Low\u2010Flow Time, and Conversion to Nonshockable Rhythm in Patients With Out\u2010of\u2010Hospital Cardiac Arrest Presenting With Initial Shockable Rhythm: A Nationwide Prospective Study in Japan"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0026-7437","authenticated-orcid":false,"given":"Kenji","family":"Kandori","sequence":"first","affiliation":[{"name":"Kyoto Daini Hospital","place":["Kyoto, Japan"]},{"name":"Shiga University of Medical Science","place":["Otsu, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Kyoto Prefectural University of Medicine","place":["Kyoto, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4068-0306","authenticated-orcid":false,"given":"Tasuku","family":"Matsuyama","sequence":"additional","affiliation":[{"name":"Kyoto Prefectural University of Medicine","place":["Kyoto, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0107-0580","authenticated-orcid":false,"given":"Tetsuhisa","family":"Kitamura","sequence":"additional","affiliation":[{"name":"Osaka University","place":["Suita, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3182-1368","authenticated-orcid":false,"given":"Hiromichi","family":"Narumiya","sequence":"additional","affiliation":[{"name":"Kyoto Daini Hospital","place":["Kyoto, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5243-8766","authenticated-orcid":false,"given":"Masahito","family":"Hitosugi","sequence":"additional","affiliation":[{"name":"Shiga University of Medical Science","place":["Otsu, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2266-476X","authenticated-orcid":false,"given":"Yohei","family":"Okada","sequence":"additional","affiliation":[{"name":"Kyoto University","place":["Sakyo\u2010ku, Japan"]},{"name":"National University of Singapore","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.12.1423"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2016.12.011"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjacc\/zuaa018"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)39903-9"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2016.11.024"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.23.3035"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2021.07.021"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2020.11.012"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005594"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2018.05.002"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/ams2.340"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1990.03440080084029"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.124.038725","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T13:38:17Z","timestamp":1788874697000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.124.038725"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,3,4]]}},"alternative-id":["10.1161\/JAHA.124.038725"],"URL":"https:\/\/doi.org\/10.1161\/jaha.124.038725","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]},"assertion":[{"value":"2024-09-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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