Cardiac arrest presenting with rhythms other than ventricular fibrillation: Contribution of resuscitative efforts toward total survivorship

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Abstract

Design:

A prospective outcome study which analyzed all out-of-hospital cardiac arrest cases in a large city for a 2-yr period in terms of presenting electrocardiogram, age, sex, presence and status of witnesses, performance of bystander cardiopulmonary resuscitation, and survival to successful hospital discharge.

Setting:

A large urban municipality (population, two million) served by a single, centralized emergency medical services program.

Patients:

Excluding cases associated with trauma, drugs, airway obstruction, submersion or primary respiratory illness, 2,404 consecutive adult out-of-hospital cardiac arrest patients were studied.

Interventions:

Standard advanced cardiac life support.

Measurements and Main Results:

Although survival “rates” of patients with asystole, idio-ventricular rhythms with pulselessness, and electromechanical dissociation were low (1.6%, 4.7% and 6.9%, respectively), 22.2% of the 193 total survivors (confidence interval: +5.9%) initially presented with one of these electrocardiographic rhythms (14 asystole, 18 idioventricular rhythms with pulselessness, 10 electromechanical dissociation, plus one other).

Conclusions:

Despite poor survival “rates,” resuscitative efforts forpatients presenting with asystole, electromechanical dissociation, and idioventricular rhythms with pulselessness all contribute significantly toward a community's total survivorship from out-of-hospital cardiac arrest. Initial, aggressive attempts at resuscitation still should be emphasized in such patients. (Crit Care Med 1993; 21:1838–1843)

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