Rearrest after prehospital resuscitation.

OBJECTIVES: To determine how often out-of-hospital cardiac arrest (OHCA) patients who achieve return of spontaneous circulation (ROSC) experience rearrest during their emergency medical services (EMS) care and to analyze their arrest characteristics, including survival to hospital discharge.

METHODS: A retrospective patient care record review was conducted for all treated OHCA patients between January 1, 2000, and February 28, 2008. Data were obtained from a countywide EMS patient care database that included treating EMS provider documentation and receiving hospital patient outcomes. If resuscitation was attempted, all OHCA patients, regardless of age, were included in the study. Those who achieved ROSC were identified and the number of patients who experienced rearrest was determined. Return of spontaneous circulation was defined as EMS documentation of a palpable pulse, and rearrest was defined as a change in cardiac rhythm associated with loss of a palpable pulse, regardless of duration. Cardiac arrest characteristics were analyzed using chi-square and t-test for resuscitated patients who experienced rearrest compared with those who did not.

RESULTS: During the study period, OHCA resuscitation was attempted on 7,296 patients. Of these, 2,454 had field ROSC (34%; 95% confidence interval [CI]: 33%-35%). Of those who achieved ROSC, 951 experienced rearrest prior to hospital arrival (39%; 95% CI: 37%-41%). The average age of the patients who experienced rearrest was 2 years higher than those who did not experience rearrest (64 years vs. 62 years; p < 0.011). The proportion of women in the rearrest group was less than that in the non-rearrest group (40% vs. 46%; p < 0.008). Bystander-witnessed arrest rates were similar between the two groups (65% vs. 68%; p < 0.124). Fewer patients who experienced rearrest survived to hospital admission (53% vs. 85%; p < 0.000) and hospital discharge (15% vs. 35%; p < 0.000). Of those who experienced rearrest, 102 (11%) experienced rearrest while being transported. There was no difference in survival for those whose rearrests occurred prior to transport (14%) compared with those whose rearrests occurred during transport (16%) (p < 0.671).

CONCLUSION: A significant number of OHCA patients who achieved field ROSC experienced rearrest prior to hospital arrival. Patients who experienced rearrest were less likely to survive.