Abstract 223: Sudden Cardiac Arrest Occurring In The Emergency Department: Prevalence, Unique Features And Survival Outcomes

Abstract

Background: The US national emergency department (ED) sample recently reported unexpectedly low survival from sudden cardiac arrest (SCA) in the ED at 10%. However, detailed, prospective community-based studies have not been conducted, especially for SCAs of likely cardiac etiology. Hypothesis: When restricted to ED SCA cases of likely cardiac etiology, survival outcomes are significantly better than reported by the US national emergency department sample. Methods: We prospectively ascertained all residents of the Portland, Oregon metropolitan area (2002- 2017) with SCA resuscitation attempted by emergency medical services (EMS) or in area EDs. All cases were required to have SCA of likely cardiac etiology. Detailed reviews were conducted of all available EMS reports and lifetime medical records including ED charts, to construct individual clinical and resuscitation profiles. Comparisons were made between cases who arrested in the ED, public and home locations. Results: We identified 4628 SCA cases with mean age 63±18, 69% male. Of these 50 (1.1%) arrested in the ED, 950 (20%) in public places, 2781 (60%) at home and 19% in other locations. ED SCA cases were intermediate in age between public and home locations (public 59±16y vs ED 60±19y vs home 64±19y, p<0.0001) and most likely to be female (ED 38% vs home 34% vs. public 15%, p <0.0001). ED SCA cases were most likely to present with shockable rhythms (ED 73%, public 66%, home 38%, p<0.0001) corresponding with the highest survival rate (ED 41% vs public 29% vs home 13%, p<0.0001). ED SCA patients also presented with the highest prevalence of warning symptoms (n=1748 with symptom information available). The two most common were chest pain (ED 54% vs public 25% vs home 26%, p=0.0003) and dyspnea (ED 44% vs public 24% vs home 34%, p=0.0004). Conclusion: In this community, ED SCA of likely cardiac etiology had 4-hold higher survival compared to the national sample, and was also observed to have unique features compared to SCA in other locations. Given the likely diverse nature of ED SCA, it would be worth considering reporting based on likely SCA etiology.