Abstract 243: Bystander CPR May Not Improve Survival from Cardiac Arrest in Patients with Epilepsy

Abstract

Introduction: Sudden cardiac arrest (SCA) is the major cause of death among patients with epilepsy and occurs in the absence of a terminal seizure in approximately two-thirds. We aimed to evaluate the effectiveness of conventional cardiac arrest resuscitation factors (Utstein elements) in predicting survival among patients with epilepsy. Methods: This analysis was conducted as part of a large, ongoing, population-based study of SCA in the Northwest US (the Oregon Sudden Unexpected Death Study, community pop. approx. 1 million). Data were obtained from multiple sources (first responders, medical practitioners and medical examiner) between 2002 and 2011 for adult patients with attempted resuscitation. Those with non-cardiac causes of arrest (e.g. severe COPD or metastatic cancer) were excluded. Those with a history of infantile febrile seizures or alcoholic withdrawal seizures were considered non-epileptic. The impact of Utstein resuscitation factors on survival to hospital discharge among patients with epilepsy was evaluated, as were differences in survival for each Utstein factor among patients with and without epilepsy. Results: There were 63 patients with epilepsy and 1403 patients without epilepsy who underwent resuscitation for SCA. The overall survival rate among patients with epilepsy was lower (3% vs 12%, p=0.014) despite identical rates of ROSC (36%, p=0.91). Survival was unaffected by any Utstein variable (age, gender, initial arrhythmia, witnessed status, location, bystander CPR, response time) and was lower for epilepsy patients receiving bystander CPR than for non-epilepsy patients (table). Conclusions: SCA survival rates for patients with epilepsy are low and are not appreciably improved by conventional resuscitation techniques. It is important to explore the basis for these observations and consider modifications to EMS activation, response and post-resuscitation hospital care in order to improve survival for patients with epilepsy.