Abstract 14891: Sudden Cardiac Arrest Manifesting With Pulseless Electrical Activity: Is There A “Sweet Spot” for Survival?

Abstract

Introduction: The proportion of sudden cardiac arrests (SCA) manifesting with pulseless electrical activity (PEA) has increased significantly, and survival rate remains poor. However, a small PEA-SCA subgroup does survive and may yield key predictors of improved outcomes when compared to non-survivors. Aim: To identify clinical and resuscitation factors that predict survival from PEA-SCA. Methods: Our study sample is drawn from two ongoing community-based, prospective studies of out-of-hospital SCA. The Portland, OR metro area (Pop. approx. 1 million; 2002-2017) was used as a discovery population and Ventura County CA (Pop. approx. 850,000, 2015-2021) was the validation population. For the present sub-study, we included SCA cases with PEA as the presenting rhythm, who were resuscitated by EMS personnel. Results: In Oregon SUDS, we identified 1,057 PEA-SCA cases of which 105 (10%) survived to hospital discharge (STHD). The mean age of PEA cases was 68.4±15.8 years and 62% were male. In a multivariable model including resuscitation variables (age, sex, witnessed SCA, EMS response time, bystander CPR, public location), age (OR 0.98, 95% CI 0.97-0.99; p=0.001), male sex (OR 0.58, 95% CI 0.38-0.88; p=0.01), witnessed SCA (OR 3.0, 95% CI 1.7-5.3; p<0001), and public location (OR 1.9, 95% CI 1.1-3.1; p=0.01) associated with STHD. In a multivariable model including clinical variables (age, sex, BMI, CAD, HF, CKD, DM, COPD, asthma), only age (OR 0.97, 95% CI 0.95-0.99; p=0.003) had an association with STHD. In Ventura PRESTO, we identified 695 PEA-SCA cases of which 82 (12%) were STHD. The mean age of PEA cases was 73.1±15.6 years and 63% were male. In a multivariable model including the same resuscitation variables, age (OR 0.97, 95% CI 0.95-0.98; p<0.001) and public location (OR 3.6, 95% CI 1.7-7.6; p=0.001) associated with STHD. In a multivariable model including the same clinical characteristics, we found no significant predictors of STHD. Conclusions: Young age and cardiac arrest in a public location were the only independent predictors of survival from PEA-SCA in both discovery and validation populations. These findings suggest that enhancement of the community response to cardiac arrest may have the potential to improve survival outcomes in PEA-SCA.