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Predicting outcomes in PEA cardiac arrest

Prehospital predictors of clinical outcomes in out-of-hospital cardiac arrest with pulseless electrical activity: a JCS-ReSS report
Resuscitation Plus · 2026-09-28 · Added 20 October 2026

A nationwide Japanese registry study of 442,630 adults with PEA out-of-hospital cardiac arrest found witnessed arrest and shorter response times predicted good neurological outcome at the scene, prehospital ROSC was the strongest predictor at hospital arrival (RR 23.31), and conversion to a shockable rhythm helped only in cardiac PEA while apparently harming non-cardiac PEA.

Study type

Registry

Design

Nationwide registry cohort with time-dependent propensity score sequential matching

Participants

442,630 adults with OHCA and initial rhythm PEA

Main finding

Witnessed arrest (RR 1.65) and prehospital ROSC (RR 23.31) predicted favourable neurological outcome at 1 month; rhythm conversion predicted good outcome in cardiac PEA but poor outcome in non-cardiac PEA (RR 0.73); apparent harm from adrenaline and advanced airway management attenuated after time-dependent adjustment

Caveat

Prognostic associations from a registry — aetiology was presumed, not confirmed, and no causality can be inferred for the rhythm-conversion findings

Bottom line

Hypothesis-generating

Learning goal

Strengthen my judgement on prognosticating outcomes when managing pulseless electrical activity in out-of-hospital cardiac arrest.

More

• Topic: Cardiac arrest
• Daily scan: 20 October 2026
• Podcast: Paramedic Papers Daily, 20 October 2026

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