High-fidelity minute-level physiologic trajectories after ROSC from linked monitor-defibrillator recordings in out-of-hospital cardiac arrest

Fouche, Pieter Francsois

doi:10.1016/j.resplu.2026.101286

High-fidelity minute-level physiologic trajectories after ROSC from linked monitor-defibrillator recordings in out-of-hospital cardiac arrest

2026-03-01

1

PRE

AI

F

Fouche, Pieter Francsois *

S

Sam Burton

F

Flanagan, Belinda

M

Meadley, Benjamin

D

David Anderson

D

Dion Stub

Z

Ziad Nehme

DOI：10.1016/j.resplu.2026.101286

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Background: Early post-ROSC physiology changes rapidly, but most studies rely on a single handover set of vital signs, which can miss trajectories and time spent hypotensive or hypoxemic. We aimed to describe minute-level early post-ROSC blood pressure and oxygenation and examine their association with outcomes. Methods: Retrospective cohort study of out-of-hospital cardiac arrest in Victoria, Australia (2019-2023). We linked the Victorian Ambulance Cardiac Arrest Registry to Zoll (R) monitor-defibrillator recordings, aligned measurements to recorded ROSC, aggregated readings into 1-min bins, and derived per-patient mean, minimum, and minutes below thresholds for SBP, MAP and SpO(2) . Associations with outcomes were modelled using adjusted logistic regression. Primary outcome was survival to hospital discharge. Secondary outcome was good 12-month neurological outcome among Results: Among 3694 patients with sustained ROSC, 1444 survived. Median ROSC-to-arrival was 58 min. Median per patient was 36 blood pressure and 97 SpO(2) values. Compared with SBP 100 mm Hg, survival was lower at 80 mm Hg (aOR 0.87, 95% CI 0.79-0.95) and higher at 140 mm Hg (aOR 1.32, 95% CI 1.11-1.59). SpO(2) 90% versus 95% was associated with lower survival (aOR 0.70, 95% CI 0.63-0.79). Longer time with SBP <90 mmHg, MAP <65 mmHg, or SpO(2) <90% was associated with lower survival. Associations with good 12-month neurological outcome were smaller and mainly limited to blood pressure. Conclusions: Minute-level monitor-defibrillator data showed strong associations between early hypotension and hypoxaemia and survival after ROSC and allow cumulative exposure to be quantified.

Keywords:

Cardiac arrest

Return of spontaneous circulation

Blood pressure

Oxygen

End-tidal carbon dioxide

Prehospital

Out-of-hospital

High-fidelity minute-level physiologic trajectories after ROSC from linked monitor-defibrillator recordings in out-of-hospital cardiac arrest

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