Secondary shockable rhythms: prognosis in cardiac arrests with initial asystole or pulseless electrical activity and subsequent shockable rhythms

Understanding outcomes for out‑of‑hospital cardiac arrest (OHCA) patients with initially nonshockable rhythms may guide future resuscitation practices. Using data from 5,445 adult atraumatic OHCAs in the ROC Epistry, we compared survival between patients who converted to shockable rhythms and those who did not. Overall survival to discharge was 7.3%; survival was 7.8% among converters and 7.1% among non‑converters, a nonsignificant difference (p = 0.47). Adjusted analyses produced similar findings. These results suggest that conversion from nonshockable to shockable rhythms does not meaningfully influence survival outcomes in OHCA.