Outcome from out-of-hospital cardiac arrest caused by nonventricular arrhythmias: contribution of successful resuscitation to overall survivorship supports the current practice of initiating out-of-hospital ACLS

S J Stratton, J T Niemann
Annals of Emergency Medicine 1998, 32 (4): 448-53

STUDY OBJECTIVE: Studies indicate that ventricular tachycardia (VT) and ventricular fibrillation (VF) are no longer the most common rhythms initially documented in out-of-hospital sudden cardiac death. Although the outcome from asystole and rhythms designated as pulseless electrical activity (PEA) is reported as poor (approximately 1% survival), resuscitative efforts for these patients are still encouraged. The purpose of this study was to determine the potential contribution that this patient group makes to overall survivorship.

METHODS: During this 2-year prospective study, all patients in cardiopulmonary arrest who were transported to the study institution after out-of-hospital Advanced Cardiac Life Support (ACLS) interventions were considered eligible for inclusion. Patients younger than 18 years of age and those in posttraumatic arrest were excluded. Age, sex, first-documented arrest rhythm, presence of a witness to the arrest, performance of bystander CPR, survival to hospital discharge, and functional status at discharge were recorded.

RESULTS: A total of 197 patients met the inclusion criteria. The initial rhythm was VF/VT in 59 (30%; 95% confidence interval [CI], 24% to 37%) and asystole/PEA in 138 (70%; 95% CI, 64% to 76%). There was 1 hospital survivor in the VT/VF group; 9 patients (7%; 95% CI, 4% to 13%) in the asystole/PEA group survived to hospital discharge. Of the asystole/PEA survivors, 100% (95% CI, 66% to 100%) had a witnessed arrest and 56% (95% CI, 21% to 86%) received bystander CPR. Fifty-six percent (95% CI, 21% to 86%) of the asystole/PEA survivors were discharged at a functional level equivalent to that preceding arrest.

CONCLUSION: In this study, patients in asystole/PEA comprised 90% of the survivors. The outcome for patients with asystole/PEA whose arrest was witnessed and who received bystander CPR may be greater than previously estimated and supports the current practice of initiating aggressive out-of-hospital ACLS in this patient group.

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