Antecedence of pulseless electrical activity (PEA) cardiac arrest in palmerston north hospital New Zealand

Abstract

Introduction: Cardiac arrest is the leading cause of death in the Western World. 1 Priori S.G. Aliot E. Blomstrom-Lundqvist C. et al. Task force on sudden cardiac death of the european society of cardiology. Eur Heart J. 2001; 22: 1374-1450 Crossref PubMed Scopus (760) Google Scholar There have been significant improvements in the management of cardiac arrest involving ventricular fibrillation (VF) and ventricular tachycardia (VT) over the last 40 years. Treatment with defibrillation within the first 6–8 min of a cardiac arrest has lead to the successful resuscitation of between 20 and 70% of patients. 2 Valenzuela T.D. Roe D.J. Nichol G. et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000; 343: 1206-1209 Crossref PubMed Scopus (1155) Google Scholar This is a small preliminary study looking at the incidence and the management of PEA arrest in a provincial New Zealand Hospital (Palmerston North). Aim: To collate information on the incidence if PEA cardiac arrest. To evaluate the management of PEA cardiac arrests by comparing the practice at resuscitations with the recommended protocols of the New Zealand Resuscitation council. Method: Cardiac arrest records that had an initial arrest rhythm of PEA and a corresponding record on the Zoll M series and AED+ were obtained and cross-referenced from October 2003 to October 2005. There were 82 patients in the study. Of all the patients, blood results within 24 h of the arrest were analysed and clinical notes were accessible. Only 62 of the initial patients had a complete set of resuscitation records, clinical notes and pre-arrest blood results. Results and conclusions: Although PEA has a very poor outcome, this small study shows that there are indicators that point to PEA arrest in the proceeding 24 h. Sixty two percent had a raised Troponin, 48% had a raised urea, 50% had increased pulse rate (100+), 50% had a low systolic pressure (<90 mmHg), 66% had a respiratory rate of more than 20 min−1 and 50% had SPO2 < 90%. A larger study needs t be undertaken to gain firmer statistical information.