Prehospital predictors of clinical outcomes in out-of-hospital cardiac arrest with pulseless electrical activity: a JCS-ReSS report.

Authors

Shumpei Kosugi, Yasunori Ueda, Haruhiko Abe, Taro Takeuchi, Koichi Inoue, Yasushi Matsumura, Naohiro Yonemoto, Tetsuya Matoba, Yoshio Tahara

Published in

Resuscitation plus. Volume 32. Pages 101508. Epub Sep 28, 2026.

Abstract

Out-of-hospital cardiac arrest (OHCA) with pulseless electrical activity (PEA) has a poor prognosis and is aetiologically heterogeneous. We aimed to identify prehospital predictors of a favourable outcome, overall and by presumed aetiology.
This nationwide cohort study analysed 442,630 adults with OHCA and an initial rhythm of PEA from the All-Japan Utstein Registry between 2005 and 2024. The primary outcome was a favourable neurological outcome at 1 month. Two models were fitted, at the scene and at hospital arrival, each also within each aetiology. Epinephrine and advanced airway management (AAM) were assessed by time-dependent propensity score sequential matching.
At the scene, a witnessed arrest (risk ratio [RR], 1.65) predicted a favourable neurological outcome, and a longer response time predicted a worse one (RR, 0.66; 10 versus 5 min). The gradient with age was steeper in cardiac than non-cardiac PEA (RR, 0.38 versus 0.78). At hospital arrival, prehospital return of spontaneous circulation (RR, 23.31) was the strongest predictor, but conversion to a shockable rhythm predicted a favourable outcome only in cardiac PEA and a worse outcome in non-cardiac PEA (RR, 1.37 versus 0.73). Standardised to a common covariate distribution, 1-month survival was higher in non-cardiac PEA, whereas a favourable neurological outcome was more likely in cardiac PEA. After time-dependent adjustment, the apparent harm from epinephrine and AAM was attenuated.
Prehospital information available before hospital arrival predicted a favourable neurological outcome, but its prognostic meaning depended on the presumed aetiology. These independent prehospital predictors could inform future risk stratification.

PMID:
42894810
Bibliographic data and abstract were imported from PubMed on 19 Oct 2026.

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